[The value of serum cystatin C for the evaluation of renal function damage in patients with proliferative diabetic retinopathy]

Objective: To investigate the value of serum cystatin C for the evaluation of renal function damage in patients with proliferative diabetic retinopathy (PDR). Methods: The clinical data of PDR patients treated in ophthalmic wards of Beijing Tongren Hospital from July 2019 to January 2021 were retrospectively analyzed. The estimated glomerular filtration rate (eGFR) was calculated by the abbreviated Modification of Diet in Renal Disease (MDRD) study equation. Based on the eGFR level, the patients were divided into no obvious renal function damage group [≥ 60 ml·min⁻¹·(1.73 m²)⁻¹] and renal inadequacy group [<60 ml·min⁻¹·(1.73 m²)⁻¹]. The clinical characteristics between the two groups were compared. Multivariate logistic regression analysis was performed to identify the relevant factors of renal inadequacy. The value of cystatin C to predict the renal inadequacy was calculated by the receiver operating characteristic (ROC) curves. Results: A total of 1 009 patients [593 males and 416 females; mean age: (52±12) years] were finally included in the study, with 192 cases (19.0%) and 817 cases (81.0%) in renal inadequacy group and no obvious renal function damage group, respectively. There were no significant statistically differences in gender, age, diastolic blood pressure, body mass index, fasting blood glucose and low-density lipoprotein between the two groups (all P>0.05). The systolic blood pressure, blood urea nitrogen, creatinine, uric acid, triglyceride, cholesterol and cystatin C were higher in the renal inadequacy group than those of no obvious renal function damage group (all P<0.05). However, the glycosylated hemoglobin, albumin and high-density lipoprotein were lower in the renal inadequacy group (all P<0.05). Multivariate logistic regression analysis showed that serum creatinine (OR=1.189, 95%CI: 1.101-1.284, P<0.001) and cystatin C (OR=3.175, 95%CI: 1.272-7.923, P=0.013) were independent risk factors for renal inadequacy in PDR patients. The ROC curve showed that cystatin C had a predictive value for renal inadequacy, with an area under the curve (AUC) of 0.966 (95%CI: 0.952-0.979). Meanwhile, the cutoff value was 1.315 mg/L, and the Youden index was 0.826, with the sensitivity of 94.3% and specificity of 88.4%. Conclusion: Serum cystatin C can be used as an important laboratory indicator to evaluate the renal impairment in PDR patients.

P–673 A visualized clinical model predicting cumulative pregnancy rate after IVF-ET: a real-world study

Study question

How is the cumulative pregnancy probability of individual patients after IVF-ET,could we develop a visualized clinical model to predict it based on patient’s characteristics?

Summary answer

The visualized clinical mode incorporates five items of female age, number of oocytes, antral follicle count, endometrium thickness and basal FSH level.

What is known already

Many factors can result in infertility, prognosis prediction is clinically relevant for making the right therapeutic strategy while avoiding overtreatment. It is also helpful in counselling, making the patient aware of possible treatment duration and estimated expense and managing patient’s expectation. Visualized clinical mode and accurate prediction would also be helpful in designing clinical trials to evaluate new treatments.

Study design, size, duration

We conducted a retrospective analysis of a single-center database using prospectively collected data from women who underwent IVF/ICSI treatment from January 2013 to December 2015, All the participants were followed up for at least 2 years, 3538 IVF-ET cycles were included in the study.A total of 3538 IVF/ICSI cycles were included in the study.

Participants/materials, setting, methods

Data from a total of 2312 IVF/ICSI cycles from January 2013 to December 2014 were randomly split into training dataset (1550, 67%) and internal validation dataset (762, 33%). A total of 1226 IVF/ICSI cycles in 2015 was applied to external validation dataset (temporal validation)

Main results and the role of chance

Multivariable logistic regression model combined with restricted cubic splines function was used to test independent prognostic factors and estimate their effects on treatment outcome for patients treated with IVF/ICSI. Female age, number of oocytes retrieved, AFC, endometrium thickness and basal FSH were included the final model. The above model was used to calculate prediction scores for all women in the training and validation datasets. The C-index was 0.693 (95% CI: 0.692∼0.695) in training sets, 0.689 in internal validation sets and 0.710 in external validation sets, which denotes a good performance. Calibration curves suggest excellent model calibration, with an ideal agreement between the prediction and actual observation . The DCA showed that if the threshold probability is between 0 and 0.7, using the nomogram derived in the present study to predict cumulative pregnancy provided a greater benefit than either thetreat-all or the treat-none strategy.

Limitations, reasons for caution

it was a retrospective, single-center study.In the future, prospective, randomized controlled, multicenter clinical studies will be designed.

Wider implications of the findings: The visualized nomogram model provides great predictive value for infertility patients in their first IVF/ICSI cycle, and predicts the pregnancy probability of individuals ,and could help clinicians improving clinical counselling.

Trial registration number

Not applicable

[Sacral nerve magnetic stimulation combined with rehabilitation training in the treatment of primary nocturnal enuresis in children]

Objective: To explore the clinical value of sacral magnetic stimulation (SMS) combined with rehabilitation training in the treatment of primary nocturnal enuresis (PNE) in children. Methods: The clinical data of 57 children with PNE admitted to the Department of Rehabilitation Xuzhou Rehabilitation Hospital, Xuzhou Central Hospital and Xuzhou Children's Hospital from October 2019 to September 2020 were collected and analyzed. The children were divided prospectively into observation group and control group by using random number table method. Bladder function training, awakening training and life and psychological intervention were performed in both groups, while the observation group was treated with SMS based on the above treatment methods. Before and after treatment, the degree and the frequency of enuresis (normal, mild, moderate, severe), therapeutic evaluation and bladder volume were compared. Chi-square test and T test were used for comparison between the two groups. Results: Finally, 28 cases in the observation group and 29 cases in the control group were included. There was no significant difference in age, sex, degree and of frequency enuresis of children between the two groups (all P>0.05).The degree of enuresis in the observation group after 1 month of treatment was better than that in the control group (12 vs. 7 cases, 8 vs. 8 cases, 5 vs. 9 cases, 3 vs. 5 cases, χ²=-2.269, P=0.030). Enuresis times in observation group was lower than that in the control group [(4.2±1.8) vs. (8.1±2.0), t=4.475, P<0.01). The total effective rate and bladder capacity of efficacy evaluation were higher than those of control group [82%(23/28) vs. 48%(14/29), (225±25) vs. (199±21) ml, Z=11.238, t=-2.249, both P<0.05]. Conclusions: SMS is an effective method for the treatment of PNE in children, which can reduce the degree and frequency of enuresis in children, increase the bladder volume and improve the total effective rate of treatment. It is worthy of clinical promotion and application.

[Influence of neuroimaging markers of chronic cerebral small vessel disease on prognosis of patients with cardioembolic stroke]

Data of 189 patients with first-ever cardioembolic stroke (CES) hospitalized in the Second People's Hospital of Changzhou from June 2014 to September 2019 were retrospectively analyzed. The neuoimaging markers of chronic small vessel disease (cSVDm) were evaluated and their total burden (0-3 points) was calculated. At 90 d after onset, 65 patients had poor prognosis. Regression analysis showed that the total cSVDm burden score was an independent riskfactor for the poor prognosis(OR=1.754, 95%CI:1.137-2.707, P=0.011).

Comparing the bone mineral density among male patients with latent autoimmune diabetes and classical type 1 and type 2 diabetes, and exploring risk factors for osteoporosis

AIMS

This study aimed to compare the bone mineral densities (BMDs) among male patients with latent autoimmune diabetes in adults (LADA), classical type 1 diabetes (T1DM), and type 2 diabetes (T2DM), and to examine the risk factors for developing low BMD in these patients.

PATIENTS AND METHODS

Between January 2017 and October 2020, a total of 57, 67, and 223 male patients with LADA, classical T1DM, and T2DM, respectively, were recruited from the endocrinology department of Shanghai Tenth People's Hospital. Hormonal markers of bone metabolism, lipid profiles, uric acid, glycosylated hemoglobin A1c (HbA1c), and beta-cell function were measured using blood samples. BMD was measured at the lumbar spine, femoral neck, and right hip by dual-energy X-ray absorptiometry.

RESULTS

The mean BMD values from all three skeletal sites in male patients with LADA were comparable to those with classical T1DM but were much lower than those with T2DM. After adjusting for confounding factors, multiple linear regression analysis demonstrated that in all male patients with diabetes, body mass index (BMI), uric acid, and fasting C-peptide showed significant positive associations with BMD at all three skeletal sites; however, osteocalcin showed a negative association at all three sites.

CONCLUSIONS

Compared with male patients with T2DM, lower BMDs were observed in patients with LADA and T1DM. Low BMI, uric acid, C-peptide levels, and high osteocalcin levels are risk factors for developing low BMD in male patients with diabetes.

Search for Displaced Leptons in sqrt[s]=13 TeV pp Collisions with the ATLAS Detector

A search for charged leptons with large impact parameters using 139  fb^{-1} of sqrt[s]=13  TeV pp collision data from the ATLAS detector at the LHC is presented, addressing a long-standing gap in coverage of possible new physics signatures. Results are consistent with the background prediction. This search provides unique sensitivity to long-lived scalar supersymmetric lepton partners (sleptons). For lifetimes of 0.1 ns, selectron, smuon, and stau masses up to 720, 680, and 340  GeV, respectively, are excluded at 95% confidence level, drastically improving on the previous best limits from LEP.

Characterization of different oligomeric forms of CRISP2 in the perinuclear theca versus the fibrous tail structures of boar spermatozoa

Mammalian sperm carry a variety of highly condensed insoluble protein structures such as the perinuclear theca, the fibrous sheath and the outer dense fibers, which are essential to sperm function. We studied the role of cysteine rich secretory protein 2 (CRISP2); a known inducer of non-pathological protein amyloids, in pig sperm with a variety of techniques. CRISP2, which is synthesized during spermatogenesis, was localized by confocal immunofluorescent imaging in the tail and in the post-acrosomal region of the sperm head. High resolution localization by immunogold labeling electron microscopy (EM) of ultrathin cryosections revealed that CRISP2 was present in the perinuclear theca and neck region of the sperm head, as well as in the outer dense fibers and the fibrous sheath of the sperm tail. Interestingly, we found that under native, non-reducing conditions CRISP2 formed oligomers both in the tail and the head but with different molecular weights and different biochemical properties. The tail oligomers were insensitive to reducing conditions but nearly complete dissociated into monomers under 8 M urea treatment, while the head 250 kDa CRISP2 positive oligomer completely dissociated into CRISP2 monomers under reducing conditions. The head specific dissociation of CRISP2 oligomer is likely a result of the reduction of various sulfhydryl groups in the cysteine rich domain of this protein. The sperm head CRISP2 shared typical solubilization characteristics with other perinuclear theca proteins as was shown with sequential detergent and salt treatments. Thus, CRISP2 is likely to participate in the formation of functional protein complexes in both the sperm tail and sperm head, but with differing oligomeric organization and biochemical properties. Future studies will be devoted to the understand the role of CRISP2 in sperm protein complexes formation and how this contributes to the fertilization processes.

Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma

BACKGROUND AND PURPOSE

Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes.

MATERIALS AND METHODS

We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features.

RESULTS

From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI.

CONCLUSIONS

Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.

[Study on construction and application of technology system of chronic diseases and risk factor surveillance in China]

To study and establish a set technology systems of sampling, investigation, quality control, and data analysis of complex sampling for chronic diseases and risk factor surveillance in China based on the requirements of the WHO and China's national conditions, and provide evidence for the policy making and prevention and control evaluation of chronic diseases and technical support for the research of chronic diseases. Through the study of complex sampling technique, adjustment of surveillance points and evaluation of their representatives, a national and provincial representative surveillance system and a complex weighted data analysis were established. According to the relevant plans, actions, and policies in China and other countries, the surveillance content and index system were studied and constructed, which was in line with China's national conditions, "1 + X" steps surveillance, covering the content of questionnaire , physical measurement, and laboratory testing. Based on modern information technology, a three-level platform of information collection and a multi-center laboratory quality control technology system were established, including sampling, information collection, biological sample management, quality control, and result display. Relying on the above research techniques, a national epidemiological investigation was conducted in China, which covered cerebrovascular disease, mental disorders, digestive system disease, and diabetes complications, to obtain the national representative data. This study reflected the innovation of "combination of medicine and prevention" and multi department cooperation in the fields of clinical medicine and public health and provided some big data for the health policy making and the evaluation of the effects of chronic disease prevention and control.

[Formation of study population for causal inference]

Epidemiological analysis describes and compares the characteristics of a certain number of people to make causal inferences. The formation of the study population is always the first step. In this paper, we first define the concepts of cross-sections at both individual level and population level and introduce the three assumptions needed in the measurements in observational studies, i. e. the true values of the attributes are stable with time, the attribute variables are independent and the individuals are independent during the measuring process. We also determine that the causal inference research should be unified based on the time of the occurrence or beginning of a postulated cause, or exposure, should be in. Then, based on the dual roles of the population cross-section with causal thinking, we propose that research designs can be classified into two types with different characteristics: history reconstruction research and future exploration research. Finally, we briefly analyze the research design framework and the relationship between estimated effects and different designs. The discussion of the formation of a study population from the perspective of causal thinking can make a foundation for the classification of causal inference research design with appropriate effect parameters, which needs to be further studied.

Adherence to antihypertensive medications for secondary prevention of cardiovascular disease events: a dose-response meta-analysis

OBJECTIVES

The aim of the study was to explore the association between adherence to antihypertensive medications (AHMs) and the risk of recurrence of cardiovascular disease (CVD) events in patients with a history of CVD events from cohort studies.

STUDY DESIGN

This is a dose-response meta-analysis.

METHODS

PubMed and Embase databases were searched up to March 4, 2021, to identify English-language reports of cohort studies that assessed the association of AHM adherence with risk of recurrence of CVD events. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association.

RESULTS

We included nine cohort studies (54,349 patients) in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.54-0.78) for the highest versus lowest AHM adherence category. We did not find any evidence of non-linearity association between AHM adherence and risk of CVD events (P_{non-linearity} = 0.534); for patients with a history of CVD events, the risk of CVD events was reduced by 9% for each 20% increase in AHM adherence (RR, 0.91; 95% CI, 0.85-0.97). The results of sensitivity analysis and subgroup analysis were virtually unchanged.

CONCLUSIONS

The high level of adherence to AHM is an effective strategy for preventing recurrence of CVD events. Patients with a history of CVD events should adhere to AHM.

A comparison of three sampling approaches for detecting PRRSV in suckling piglets

Determining whether porcine reproductive and respiratory syndrome virus (PRRSV) is circulating within a breeding herd is a longstanding surveillance challenge. Most commonly, piglets in farrowing rooms are sampled to infer the PRRSV status of the sow herd, with sample size based on the expectation of hypergeometric distribution and piglet selection based on simple random sampling (SRS), i.e., randomly selecting individuals from a population in a manner that all individuals have equal chance of being selected. Conceptually straightforward, the assumptions upon which it is based (homogeneous population and independence of individuals) rarely hold in modern swine facilities. Alternative approaches for sample selection include two-stage stratified sampling (2SS), i.e., randomly selecting litters (first stratum) and randomly selecting piglets (second stratum) within selected litters, and risk-based sampling (RBS), i.e., selecting litters with a higher risk of having viremic piglets, and randomly selecting pigs within those litters. The objectives of this study were to 1) characterize the pattern of distribution of PRRSV-viremic piglets in farrowing rooms and 2) compare the efficiency of SRS, 2SS, and RBS for the detection of PRRSV-viremic piglets. In 12 sow farms, serum samples were collected from all 4510 piglets in 422 litters housed in 23 farrowing rooms and tested for PRRSV RNA. At the population level, the distribution of PRRSV-viremic pigs was analyzed for population homogeneity and spatial clustering. At the litter level, litter size and sow parity were evaluated as risk factors. A non-homogeneous distribution of PRRSV-viremic piglets was observed in nearly all farrowing rooms (15/16), and spatial clustering detected on 11 occasions (11/16). Simulated sampling based on farrowing room data determined that 2SS required 1-to-25 fewer samples than SRS to detect ≥ 1 viremic piglet in 13 of 16 rooms and the same number of samples in 3 rooms. RBS required 1-to-7 fewer samples than 2SS to detect ≥ 1 viremic piglet in 7 of 16 rooms, the same number of samples in 6 rooms, and 1 more sample in 3 rooms. Notably, SRS was less efficient than either 2SS or RBS in detecting PRRSV-viremic piglets in farrowing rooms, regardless of the confidence level. It may be concluded that the core assumptions upon which most current surveillance methods are based do not hold in modern farrowing room facilities. Simulation-based sample size tables for SRS and 2SS are provided.

TRPS1 knockdown inhibits angiogenic vascular mimicry in human triple negative breast cancer cells

PURPOSE

Vascular mimicry (VM) tubules are lumen structures comprised of malignant tumor cells without the participation of endothelial cells. VM simulates blood vessel function in tumors to deliver a sufficient blood supply for proliferation, invasion, and metastasis of malignant tumors, thereby reducing the clinical effects of anti-angiogenic treatments. The elimination or prevention of malignant tumor VM development therefore represents an urgent research goal as a therapeutic strategy to and cut off nutrients required for tumor growth. The GATA transcription factor TRPS1 is abnormally up-regulated in breast cancer, osteosarcoma, prostate cancer, and other tumor tissues, and is instrumental in regulating cell proliferation, differentiation, and tissue growth and development.

METHODS

Here, we explored the effects of TRPS1 knockdown on VM and the proteins underlying its development in triple-negative breast cancer cell line MDA-MB-231.

RESULTS

We found that TRPS1 knockdown resulted in obvious inhibition of VM development. Fluorescence microscopy of F-actin and tubulin revealed that loss of TRPS1 function resulted in disruption of cytoskeleton and microtubule formation, respectively. In addition, TRPS1-suppressed cells exhibited reduced accumulation of VM-associated proteins EphA2, MMP-2, MMP-9, VEGF, and VE-cadherin. Moreover, it is interesting to know that the capacity for migration and invasion were limited in MDA-MB-231cells after TRPS1 knockdown and that the average number of VM tubules, their length, and number of intersections were also significantly decreased.

CONCLUSIONS

Based on our results, and in light of previous studies, we thus proposed that TRPS1 suppression negatively affects vascular mimicry possibly through reduced TRPS1-mediated transcriptional regulation of VM-related protein VEGF-A.

Climate and air pollution exposure are associated with thyroid function parameters: a retrospective cross-sectional study

OBJECTIVES

There are still controversies about the impact of climatic and environmental factors on thyroid function parameters in healthy populations. We investigated the relationships between climate, air pollution exposure, and thyroid function fluctuations.

METHODS

We retrospectively reviewed 327,913 individuals attending routine health checks from December 2013 to December 2018. We analyzed the associations between thyroid function and climatic factors using Spearman's correlation analysis. We explored the relationships between thyroid function and air pollution exposure using multiple linear regression analysis, after adjusting for age, sex, season, and outdoor temperature. We also performed subgroup analyses by age and sex and sensitivity analyses of different anti-thyroid peroxidase antibody status.

RESULTS

Thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) were negatively associated with outdoor temperature (r = - 0.66, P < 0.001; r = - 0.55, P < 0.001), while free thyroxine (FT4) and FT4/FT3 were positively associated with temperature (r = 0.35, P < 0.001; r = 0.79, P < 0.001). An increase of 10 μg/m³ in fine particulate matter ≤ 2.5 μm (PM2.5) was associated with a decrease of 0.12 pmol/L in FT4 and an increase of 0.07 pmol/L in FT3 (both P < 0.01). FT4/FT3 was significantly negatively associated with PM2.5 (coefficient: - 0.06, P < 0.01). These results remained robust in hierarchical analyses and sensitivity analyses.

CONCLUSIONS

Thyroid function parameters are associated with climate and air pollution exposure. These factors may influence variations in thyroid function. Our results also highlight the importance of public health interventions to reduce air pollution.

MiR-506 alleviates myocardial ischemia-reperfusion injury via targeting PI3K/AKT

OBJECTIVE

The aim of this study was to explore the effects of micro ribonucleic acid (miR)-506 and phosphatidylinositol 3-hydroxy kinase (PI3K)/protein kinase B (AKT) pathway on myocardial ischemia-reperfusion injury (MIRI) in rats.

MATERIALS AND METHODS

A total of 90 healthy rats weighing 260-300 g were selected as research subjects, and divided into three groups, including: Control group (n=30), IR group (n=30), and miRNA treatment group (IR + miR-506 group, n=30). The model was successfully established via threading the coronary artery. The structural differences in myocardial tissues were observed via hematoxylin-eosin (HE) staining in each group. The mRNA expressions of miR-506 and PI3K in myocardial tissues were detected using fluorescence quantitative Polymerase Chain Reaction (qPCR). Meanwhile, AKT protein phosphorylation activity in myocardial tissues was detected as well. The apoptosis of myocardial tissues was detected via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. In addition, superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in myocardial tissues were compared in each group.

RESULTS

In Control group, no structural abnormalities were found in myocardial tissues, and no inflammatory cells were observed. In IR group, myocardial tissues were arranged disorderly, and inflammatory cell infiltration was found. In IR + miR-506 group, myocardial tissue lesions were milder than those in the IR group. qPCR results indicated that the mRNA expressions of miR-506 and PI3K in myocardial tissues were statistically different among groups (p<0.05), with the lowest in the IR group. The expression of miR-506 was evidently higher in IR + miR-506 group than that in the Control group (p<0.05). However, the mRNA expression of PI3K was significantly higher in the Control group than IR + miR-506 group (p<0.05). There was a significant positive correlation between the expressions of miR-506 and PI3K in each group (p<0.05). The phosphorylation activity of AKT protein in IR + miR-506 group was markedly higher than the other two groups (p<0.05). In addition, TUNEL staining demonstrated that the apoptosis rate in Control group, IR group and IR + miR-506 group was only 1.3%, 20.3%, and 9.8%, respectively. SOD activity was remarkably stronger in the Control group (62.7 U/mg pro) than the other two groups (p<0.05). In addition, MDA content was remarkably higher in IR group (0.747 nmol/mg pro) than that in the other two groups (p<0.05).

CONCLUSIONS

MiR-506 is associated with myocardial injury in rats, which can alleviate myocardial injury through the PI3K/AKT signaling pathway.

[Analysis of cervical cancer screening and related factors in China]

Objective: To study the cervical cancer screening rate and related factors among women in China. Methods: In 2015, Chinese Chronic Diseases and Risk Factors Surveillance in Adults was conducted in 298 counties or districts using the multistage stratified cluster sampling in China. The study investigated 91 348 women aged 20 years or older who lived in the local at least 6 months in the past year. We collected the information about cervical cancer screening and socio-demographic factors through face-to-face interview. The screening rate was calculated by the complex sampling design and populating weighting. Rao-Scott χ2 was used to test the differences in screening rates within subgroups. Multivariable logistic regression was used to explore the factors associated with the uptake of cervical cancer screening. Results: The mean age of participants was (51±14) years old. The cervical cancer screening rate was 23.6% (n=21 346), and there was a significant difference in the screening rates among age groups. The cervical cancer screening rate in women aged 40-49 years was 34.8% (n=7 043). There was significant difference in the screening rates among geographic areas and the highest screening rate was 27.9% (n=6 707) in the eastern China. The more likelihood of uptake of cervical cancer screening was significantly associated with living in high-income regions, higher education, non-agriculture employment, higher household income, having medical insurance, and having health check-up during the past three years, and the cervical screening rate was higher (all P<0.05) . Conclusion: The cervical cancer screening rate is low in China and there was significant difference in the age and geographic areas. The uptake of cervical cancer screening is associated with local economic status, household income, education, employment, health insurance, and health check-up.

[Pre-clinical in vivo evaluation study on a new Chinese-made surgical biopatch for atrial septum]

Objective: To evaluate the safety and effectiveness of a new Chinese-made surgical biopatch for atrial septum under the establishment of atrial septal defect animal model in miniature pigs. Methods: From June 2018 to April 2019, 26 pigs were divided into experimental group (15 pigs) and the control group (11 pigs). Animal models of atrial septal defect were established by traditional surgical methods. The to-be-evaluated and listed surgical biological patches (with a diameter of 10 mm) were implanted in the experimental group and the control group to repair the atrial septal defect. Cardiac ultrasound and blood examination of all animals were performed before and at 7, 30, 90, 180 days after operation, the results were analyzed with repetitive measurement and analysis of variance. At 90 days and 180 days after the operation, tissue samples were taken from animals after euthanasia. Pathological examination of heart and major organs were conducted. The independent sample t test and rank sum test were used to compare the data between the two groups, and the nonparametric was used to compare the patch calcification score between the two groups. Results: In total of 26 animals, 14 animals in the experimental group(6 at 90 days, 8 at 180 days) and 9 animals in the control group(4 at 90 days, 5 at 180 days) reached the end of the experiment. The other 3 animals (1 in the experimental group and 2 in the control group) died of arrhythmia, whole heart failure and right heart failure, the results of pathological examination showed that the causes of death were unrelated to the experimental materials. Cardiac ultrasound showed no patch leakage in all animals. There was no statistically significant difference in cardiac ultrasound and blood examination between the two groups at different time points after operation (all P>0.05). The pathological results showed that all the implants were intact and had good biocompatibility. There was no significant difference in the mean endothelialization rate between the experimental group and the control group at 90 and 180 days after operation ((80.8±29.1)% vs. (82.5±23.6)%, t=0.095, P=0.927; (78.8±36.4)% vs. (82.0±19.2)%, t=0.182, P=0.859) on 90 and 180 days, there was no significant difference in the patch calcification score between the two groups (1.00(1.25) vs. 2.00(0.75), Z=6.500, P=0.214; 0(0.75) vs. 1.00(2.00), Z=12.000, P=0.139). Conclusion: The new Chinese-made surgical biopatch for atrial septum has comparable safety and efficacy to that of the marketable patch in miniature pig atrial septal defect animal model.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Dupilumab reduces systemic corticosteroid use and sinonasal surgery rate in CRSwNP

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease with a high symptom burden and poor quality of life. Treatment options include recurrent surgeries and/or frequent systemic corticosteroids (SCS). Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2-mediated inflammation. We report results of pooled analyses from 2 randomised, double-blind, placebo-controlled phase 3 studies (SINUS 24 [NCT02912468]; SINUS-52 [NCT02898454]) to evaluate dupilumab effect versus placebo in adults with CRSwNP with/without SCS use and sinonasal surgery.

METHODOLOGY

SINUS-24 patients were randomised 1:1 to subcutaneous dupilumab 300 mg (n=143) or placebo (n=133) every 2 weeks (q2w) for 24 weeks. SINUS-52 patients were randomised 1:1:1 to 52 weeks of subcutaneous dupilumab 300 mg q2w (n=150), 24 weeks q2w followed by 28 weeks of dupilumab 300 mg every 4 weeks (n=145) or 52 weeks of placebo q2w (n=153).

RESULTS

Dupilumab reduced the number of patients undergoing sinonasal surgery (82.6%), the need for in-study SCS use (73.9%), and SCS courses (75.3%). Significant improvements were observed with dupilumab vs placebo regardless of prior sinonasal surgery or SCS use in nasal polyp, nasal congestion, Lund-MacKay, and Sinonasal Outcome Test (22-items) scores, and the University of Pennsylvania Smell Identification Test.

CONCLUSIONS

Dupilumab demonstrated significant improvements in disease signs and symptoms and reduced the need for sino-nasal surgery and SCS use versus placebo in patients with severe CRSwNP, regardless of SCS use in the previous 2 years, or prior sinonasal surgery.

Finding PRRSV in sow herds: Family oral fluids vs. serum samples from due-to-wean pigs

The aim of this study was to compare the detection of porcine reproductive and respiratory syndrome virus (PRRSV) in due-to-wean litters in commercial swine breeding herds using family oral fluids (FOF) vs. individual piglet serum samples. FOF and piglet serum samples were collected in 199 due-to-wean litters on six farms containing 2177 piglets. All samples were individually tested for PRRSV RNA by RT-rtPCR. A litter was considered PRRSV-positive when PRRSV RNA was detected in ≥ 1 piglet serum sample or the FOF sample. Mixed effect logistic regression with farm as a random effect was used 1) to evaluate the probability of obtaining a PRRSV RNA positive FOF as a function of the proportion of viremic piglets in a litter and 2) the effect of litter size and parity on the probability that a litter would test PRRSV RNA positive in FOF. A Bayesian prevalence estimation under misclassification (BayesPEM) analysis was used to calculate the PRRSV prevalence and 95 % credible interval given the condition that all samples (FOF and serum) tested negative. In total, 34 of 199 litters (17.1 %) contained ≥ 1 viremic piglet(s), and 28 of 199 litters (14.1 %) were FOF positive. When all piglet serum samples within a litter tested negative, 1 of 165 FOF (0.6 %) tested PRRSV RNA positive. The probability of a PCR-positive FOF sample from litters with 10 %, 20 %, 30 %, 40 %, and 50 % within-litter PRRSV prevalence was 3.5 %, 35.1 %, 88.8 %, 99.2 %, and >99.9 %, respectively. The odds of a PCR-positive FOF in a first parity litter were 3.36 times (95 % CI: 2.10-5.38) that of a parity ≥ 2 litter. The odds of a positive FOF result in a litter with ≤ 11 piglets were 9.90 times (95 % CI: 4.62-21.22) that of a litter with > 11 piglets. FOF was shown to be an efficacious sample type for PRRSV detection in farrowing rooms. A risk-based approach for litter selection combined with FOF collection can be used to improve on-farm PRRSV detection with a limited sample size, compared to sampling multiple individual pigs. Finally, the BayesPEM analysis showed that PRRSV may still be present in breeding herds when all samples (serum and FOF) test PRRSV RNA negative, i.e., negative surveillance results should be interpreted with caution.

[Characteristics of primary cutaneous rare nasal extranodal NK/T cell lymphoma: a clinicopathological study of 15 cases]

Objective: To investigate the clinicopathological features and differential diagnosis of primary cutaneous nasal extranodal NK/T cell lymphoma (pcENKTCL-NT). Methods: Fifteen cases of pcENKTCL-NT were collected at the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019. The clinical characteristics, morphological features, immunophenotypes, and results of in situ hybridization and gene detection were analyzed. Results: Among the 15 patients, 7 were male and 8 were female, with a male to female ratio of 1.0∶1.1. Their ages ranged from 29 to 86 years, and the median age was 59.3 years. All patients were hospitalized for skin lesions, including skin ulcers, scattered patchy red papules, and local blisters. The skin lesion might be a hard nodular mass, and part of it was a confluent patchy erythema; it could be manifested as multiple scattered nodules of different sizes, and some lesions were like round ulceration. There were 8 cases of lower limbs, 4 cases of chest (1 case with upper limb lesions), 2 cases of trunk and 1 case of neck. Most of the patients were sensitive to GGDP regimen (cisplatin, dexamethasone, gemcitabine and pemostatin). Histologically, most lesions showed tumor cells invading the epidermis and skin appendages, dermal infiltration, diffuse distribution, vascular and peritubular destruction, and some subcutaneous adipose tissue involvement. Morphologically, most of the tumor cells were mixed with small-to medium-size lymphocytes, and some were large cells, mixed cells or small cells. Immunohistochemistry showed that CD3, CD3 ε and TIA-1 were expressed in all cases, but not CD20 and CD8. CD56 and granzyme B were expressed in most of the cases, and CD5 was not expressed. Ki-67 positive index was about 50%-90%. EBV in situ hybridization was positive in all cases. The clonal rearrangement of T cell receptor gene was found in some CD56 negative cases. The 15 patients were followed up for 5-45 months, and one of them was lost to follow-up. Five patients died within 5-13 months after the diagnosis, accounting for 35.7% (5/14) of the 14 patients. The average survival time of the deceased patients was 8.6 months. Conclusions: The incidence rate of pcENKTCL-NT is relatively low, but its biological behavior is aggressive and its prognosis is overall poor. Its skin lesions and histopathological features are relatively diverse. The diagnosis should be determined with using clinical data, histological morphology, immunophenotype and EB virus in situ hybridization. At the same time, attention should be paid to differential diagnosis from other cutaneous lymphoma with cytotoxic phenotype to avoid missed diagnosis and misdiagnosis.

[The application of continuous glucose monitoring in the management of hepatic glycogen storage disease]

Objective: Continuous glucose monitoring (CGM) were performed in children with hepatic glycogen storage disease (GSD) to accurately understand the situation of glucose levels during their treatment, and to provide support for optimizing their nutritional management. Methods: In this retrospective research, 42 patients with hepatic GSD who under went 72 h CGM were collected from Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from October 2019 to January 2020. According to the genetic test results, they were divided into 5 groups: type Ⅰa, type Ⅰb, type Ⅲa, type Ⅵ and type Ⅸa. After long-term follow up and regular treatment, the clinical data (induding course, age, height, weight and biochemical parameters, etc.) on the day of CGM were summarized, and 72 h CGM were performed to assess the occurrence of hypoglycemia and hyperglycemia.χ² test, Fisher exact probability method, t test, analysis of variance or nonparametric test were used for comparison between groups. Results: Forty-two cases of hepatic GSD patients included 25 males and 17 females (20 cases of type Ⅰa, 3 cases of type Ⅰb, 10 cases of type Ⅲa, 3 cases of type Ⅵ and 6 cases of type Ⅸa).The age was 9.5 (6.7, 12.9) years, and the course of disease was 6.8 (5.1, 11.3) years. The average levels of glucose of the patients were all normal. However, the levels of standard deviation of blood glucose (SDBG) and mean amplitude of glycemic excursion (MAGE) were significantly different (F=2.747, 3.029,both P<0.05). Among them, the SDBG of type Ⅰa and Ⅲa were significantly higher than those of type Ⅸa ((1.10±0.36), (0.98±0.30) vs. (0.62±0.26) mmol/L, t=3.010, 2.440, both P<0.05), while the MAGE of type Ⅰ was higher than that of Ⅸa and Ⅲa ((2.3±0.9) mmol/L vs. (1.2±0.6) and (1.7±0.6) mmol/L, t=2.734, 2.302, both P<0.05, respectively). Conclusions: CGMS can accurately assess the fluctuations of blood glucose and effectively detect hidden hypoglycemia and hyperglycemia in hepatic GSD patients. For different types of hepatic GSD, individualized corn starch treatment doses should be given according to the different situation of blood glucose, so as to optimize the patient's treatment and improve their prognosis.

Gene alteration in zebrafish exposed to a mixture of substances of abuse

A recent surge in the use and abuse of diverse prescribed psychotic and illicit drugs necessitates the surveillance of drug residues in source water and the associated ecological impacts of chronic exposure to the aquatic organism. Thirty-six psychotic and illicit drug residues were determined in discharged wastewater from two centralized municipal wastewater treatment facilities and two wastewater receiving creeks for seven consecutive days in Kentucky. Zebrafish (Danio rerio) larvae were exposed to the environmental relevant mixtures of all drug residues, all illicit drugs, and all prescribed psychotic drugs. The extracted RNA from fish homogenates was sequenced, and differentially expressed sequences were analyzed for known or predicted nervous system expression, and screened annotated protein-coding genes to the true environmental cocktail mixture. Illicit stimulant (cocaine and one metabolite), opioids (methadone, methadone metabolite, and oxycodone), hallucinogen (MDA), benzodiazepine (oxazepam and temazepam), carbamazepine, and all target selective serotonin reuptake inhibitors including sertraline, fluoxetine, venlafaxine, and citalopram were quantified in 100% of collected samples from both creeks. The high dose cocktail mixture exposure group revealed the largest group of differentially expressed genes: 100 upregulated and 77 downregulated (p ≤ 0.05; q ≤ 0.05). The top 20 differentially expressed sequences in each exposure group comprise 82 unique transcripts corresponding to 74% annotated genes, 7% non-coding sequences, and 19% uncharacterized sequences. Among 61 differentially expressed sequences that corresponded to annotated protein-coding genes, 23 (38%) genes or their homologs are known to be expressed in the nervous system of fish or other organisms. Several of the differentially expressed sequences are associated primarily with the immune system, including several major histocompatibility complex class I and interferon-induced proteins. Interleukin-1 beta (downregulated in this study) abnormalities are considered a risk factor for psychosis. This is the first study to assess the contributions of multiple classes of psychotic and illicit drugs in combination with developmental gene expression.

OP0314 DOCK8 MUTATIONS IN COVID-19 AND MIS-C CYTOKINE STORM SYNDROME

Background:

We recently identified DOCK8 as a novel gene associated with cytokine storm syndrome (CSS)1. Heterozygous missense mutations in DOCK8 diminish NK cell lytic function and contribute to increased pro-inflammatory cytokine production (CSS). CSS is a potential complication of COVID-19 with severe consequences2. Children are at risk of a SARS-CoV-2 post-infectious CSS, multisystem inflammatory syndrome in children (MIS-C)3. Host genetic factors associated with COVID-19 CSS and MIS-C CSS are unknown.

Objectives:

The goals are to identify and functionally study rare mutations in DOCK8 in patients with SARS-CoV-2 COVID-19 and MIS-C.

Methods:

To date, 16 adult patients enrolled in a COVID-19 CSS clinical trial at UAB had whole genome sequencing. Four (25%) had rare heterozygous DOCK8 mutations (3 missense, 1 intronic). A COVID-19 CSS adult patient in Seattle also had a DOCK8 missense mutation. In addition, DOCK8 missense mutations were identified in five children (UAB & Northwell) hospitalized with MIS-C. DOCK8 mutations, or wild-type (WT) sequence controls, were introduced into human NK-92 cells by FOAMY virus transduction. WT and mutant DOCK8-expressing NK-92 cells were incubated with K562 target cells and compared for cytolysis and degranulation (CD107a).

Results:

One COVID-19 patient DOCK8 mutation (Gly523Arg) reduced NK cell degranulation by 30% and cytolysis by 23% (n=3) (Figure 1). Similar studies of 3 MIS-C patients with DOCK8 missense mutations (Arg899Trp, Ala2Thr, Pro687Leu) revealed up to 31% reduced NK cell degranulation and 48% reduction in cytolysis by 3 distinct mutations (n=3). Two-way ANOVA analysis revealed statistically significant (p<0.05) differences in NK cell degranulation and lysis for four unique DOCK8 mutations.

Conclusion:

Heterozygous DOCK8 missense mutations may contribute to severe COVID-19 and MIS-C CSS by partial dominant-negative effects yielding decreased NK cell cytolysis.

References:

[1]Schulert GS, Cron RQ. The genetics of macrophage activation syndrome. Genes Immun 2020:21:169-181.

[2] Cron RQ, Chatham WW. The rheumatologist’s role in COVID-19. J Rheumatol 2020:47:639-642.

[3]Reiff D, Mannion ML, Samuy N, Scalici P, Cron RQ. Distinguishing active pediatric COVID-19 from MIS-C. Pediatr Rheumatol Online J, in press.

Disclosure of Interests:

Randy Cron Consultant of: SOBI, Novartis, Pfizer, Sironax, Grant/research support from: SOBI, Mingce Zhang: None declared, Remy Cron: None declared, Devin Absher: None declared, John Bridges: None declared, Amanda Schnell: None declared, Pavan Bhatraju: None declared, Anshul Vagrecha: None declared, Shannon Lozinsky: None declared, Suchitra Acharya: None declared, Carolyn Levy: None declared, Winn Chatham Grant/research support from: SOBI.

POS0398 ADIPONECTIN INDUCES SYNOVIAL ANGIOGENESIS IN RHEUMATOID ARTHRITIS THROUGH METABOLIC REMODELING

Background:

Our team have previously reported that Adiponectin correlates well with synovial inflammation and progressive bone erosion in rheumatoid arthritis (RA). Angiogenesis is another important part, which plays a critical role in the pathogenesis of RA.

Objectives:

We hypothesized that adiponectin induces synovial angiogenesis in RA.

Methods:

Single-cell RNA sequencing (scRNA-Seq) was used to screen cellular changes in local knee joint of collagen-induced arthritis (CIA) after intraarticularly injected of adiponectin. Chimera models of synovium-cartilage-NOD/SCID mice, matrigel plug assay and rat aortic ring assay were performed to demonstrate the pro-angiogenesis role of adiponectin. Cellular experiment, including proliferation, migration, apoptosis, tube formation and angiogenesis related gene expression profile, were detected with Human Umbilical Vein Endothelial Cells (HUVEC) and Mice Lung Microvessel Endothelial Cell (MLMEC) after adiponectin stimulation. Seahorse was performed to clear the influence of adiponectin to cell metabolism.

Results:

The synovium and pannus hyperplasia worse in CIA model after intraarticularly injected of adiponectin, along with more serious synovitis and bone erosion. ScRNA-Seq of synovial tissues separated from CIA reminded that endothelial cell barbarically grows via metabolic remodeling after stimulated with adiponectin. Synovial chimera, matrigel plug and rat aortic ring shows adiponectin accelerates angiogenesis significantly in different background conditions. In vitro, endothelial cell proliferation detecting by RCTA and CCK8, migration by wound healing and transwell, apoptosis by FACS, tube formation and angiogenesis related gene expression profile by PCR-ARRAY were promoted by adiponectin in both HUVEC and MLMEC. Seahorse showed HUVEC made more use of glycolysis after co-cultured with adiponectin, a method of cell energy supply that tumor cells possess called warburg effect, that drives endothelial cell hyperplasia in severe environment.

Conclusion:

As a classic metabolic regulator, adiponectin exacerbates CIA by promoting angiogenesis through metabolic remodeling. The findings not only provide a novel insight into the pathogenic role of adiponectin, but also reveals a potential therapeutical strategy to attenuate revascularization in RA.

Disclosure of Interests:

None declared

POS0776 CORRELATION OF PERIPHERAL CD4+GRANZB+CTLS WITH DISEASE SEVERITY IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background:

Sjögren’s syndrome (SS) is a chronic autoimmune disorder. The major histopathologic lesion of it is a focal lymphocytic infiltrate around ductal and acinar epithelial cells, which include a majority of CD4+T. Several studies have shown that the epithelial cells in SS present diverse phenomena, such as MHC class II overexpression. CD4+T cells with cytotoxic activity (CD4 CTL) have been detected in various immune responses. They are characterized by their ability to secrete perforin and granzyme B to kill the target cells in an MHC class II-restricted fashion.

Objectives:

So this study was to investigate the correlation of peripheral CD4+GranzB+CTLs with disease severity and organ involvement in patients with primary Sjögren’s syndrome.

Methods:

We recruited 116 pSS patients and 46 healthy controls using flow cytometry to examine proportion of CD4+GranzB+CTLs in their peripheral blood, and immunofluorescence to test the expression of CD4+GranzB+CTLs in labial gland. The correlations of CD4+GranzB+CTLs and the relevant clinical data were analyzed.

Results:

We analyzed the percentage of CD4+GranzB+cytotoxic T cells in peripheral blood mononuclear cells (PBMCs) by flow cytometry. Frequency of peripheral CD4+GranzB+CTLs were measured in 116 patients with pSS and 46 healthy controls matched for age and sex. The percentage of CD4+GranzB+CTLs were significantly up-regulated in pSS patients than healthy controls (7.1%±4.9% vs 3.1%±1.9%, p <0.0001) and positive correlation with ESSDAI in pSS patients(r = 0.6332, p<0.001). The percentage of CD4+GranzB+CTLs were markedly higher in pSS patients with extraglandular manifestations. Moreover, CD4+GranzB+CTLs were observed in the lymphocytic foci and periductal areas of the LSGs and were elevated with increased foci index (FI). After excluding the other risk factors associated with pSS, CD4+GranzB+CTLs were still related to ESSDIA and extraglandular manifestations independently(p<0.05). ROC curve analysis indicated that the area under the curve (AUC) of CD4+GranzB+CTLs was 0.796 to predict the activity of pSS, and 0.851 to presume extraglandular manifestations. The best diagnostic cut-off point was 4.865 for pSS patients.

Conclusion:

In this study, We provide new evidence indicating involvement of CD4+GranzB+CTLs over activation in the disease pathophysiology of pSS, which may serve as a new biomarker to evaluate the activity and severity of pSS.

References:

[1]Takeuchi A, Saito T. Front Immunol. (2017) 23:194.

[2]Brown DM, et al. Front Immunol. (2016) 9:93.

[3]Polihronis M, et al. Clin Exp Immunol. (1998) 114:485-90.

[4]Xanthou G, et al. Clin Exp Immunol. (1999) 118:154-63.

[5]Maehara T, et al. Ann Rheum Dis. (2017) 76:377-385.

[6]Goules AV, et al. Clin Immunol. (2017) 182:30-40.

[7]Hashimoto K, et al. Proc Natl Acad Sci U S A. (2019) 116:24242-24251.

[8]Croia C, et al. Arthritis Rheumatol. (2014) 66:2545-57.

[9]Schmidt D,et al. J Clin Invest. (1996) 97:2027–37.

[10]Pandya JM, et al. Arthritis Rheum. (2010) 62:3457–66.

[11]Moosig F, et al. Clin Exp Immunol. (1998) 114:113–8.

[12]Peeters LM, et al. Front Immunol. (2017) 20:1160.

Table 1.

Multivariate analysis of CD4+GranzB+CTLs influenced by pSS-related factors

regression coefficientstandard errort-statisticsp value95%CICD8+GranzB+CTLs(%)0.1440.0334.3346.9E-50.077, 0.211ESSDAI0.2560.1222.0950.0410.011, 0.502extraglandular manifestations2.6121.2682.0590.0450.065, 5.158Figure 1.

Receiver operating characteristic (ROC) curve of the frequency of CD4+GranzB+CTLs to predict ESSDAI and extraglandular manifestations response

Disclosure of Interests:

None declared

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Breast ductal carcinoma in situ with micro-invasion versus ductal carcinoma in situ: a comparative analysis of clinicopathological and mammographic findings

AIM

To determine the differences in clinicopathological and mammographic findings between ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with micro-invasion (DCIS-MI) and explore clinicopathological and mammographic factors associated with DCIS-MI.

MATERIALS AND METHODS

All DCIS patients with or without micro-invasion who underwent preoperative mammography at The Affiliated Hospital of Qingdao University from January 2016 through June 2020 were identified retrospectively. The correlations of clinicopathological findings with DCIS-MI were evaluated using univariate and multivariate binary logistic regression analyses. Imaging findings were compared between the groups by using the Pearson chi-square test.

RESULTS

A total of 445 DCIS lesions and 151 DCIS-MI lesions were included in the final analysis. Large extent (≥2.7 cm), high nuclear grade, comedo-type, negative progesterone receptor (PR), negative oestrogen receptor (ER), high Ki-67 and axillary lymph node metastasis were more frequently found in DCIS-MI than in DCIS (all p<0.05), and the first four of these were found to be independent predictors of DCIS-MI in the multivariate analysis (all p<0.05). Regarding imaging findings, compared to DCIS, DCIS-MI showed fewer occult lesions and more lesions with calcifications in mass, asymmetry, and architectural distortion (p=0.004). Grouped calcifications were usually associated with DCIS, while regional calcifications were commonly found in DCIS-MI (p<0.05).

CONCLUSION

Large extent, high nuclear grade, comedo-type and negative PR were found to be independent predictors of DCIS-MI. Lesions with calcifications and regional calcifications were more likely associated with DCIS-MI on mammography.

Composition and structural characterization of pectin in micropropagated and conventional plants of Premma puberula Pamp

The metabolites produced by plants can be enhanced by plant tissue culture. In Premma puberula Pamp., the pectin content in leaves is 30 %-40 %, and it is widely used in the food industry and medicine. However, inefficient propagation has seriously restricted the utilization of pectin resources. Therefore, we established an efficient micropropagation technology for P. puberula through comparative analysis in mature leaves of regenerated and conventionally propagated plants. The results showed that the pectin composition of their leaves was similar in terms of galacturonic acid, monosaccharide composition, degree of esterification, functional groups, nuclear magnetic resonance spectrum and morphological characteristics. Furthermore, micropropagated plants had better hardness, gumminess and chewiness characteristics than conventionally propagated plants and were similar in emulsion stability, adhesiveness, springiness, cohesiveness and viscoelasticity. Therefore, micropropagation technology will provide an important guarantee for the industrial production of pectin from P. puberula. The technical essentials include callus induction, embryoid formation, and root induction, followed by acclimatization and transplanting.

TGF-β1/WISP1/Integrin-α interaction mediates human chondrocytes dedifferentiation

OBJECTIVE

To clarify the interaction between TGF-β1 and WISP1, and the effect of Integrin α5/V subunits on the WISP1 caused chondrocyte (CH) dedifferentiated phenotype.

PATIENTS AND METHODS

The knee joint cartilage from the trauma and osteoarthritis (OA) patients were collected. The patients of trauma group were confirmed to have no OA history. The protein level of WISP1, Integrin-α5/V, and type II/I collagen were analyzed by Western blotting. Besides, we isolated the CHs from the cartilage without OA and treated CHs with exogenic TGF-β1 and WISP1 protein. In addition to this, to regulate the α5 and αV subunits expression of CHs, we silenced two genes by siRNA transfection and upregulated them by exogenic protein supplement. Then, the CHs with different α5 and αV expression were treated with WISP1. To value the chondrogenic gene expression, we determined the type II collagen and SOX9 gene expression by immunofluorescence (IF) and RT-PCR, respectively. Meanwhile, the dedifferentiation markers of CH, type I collagen, and Runx2 expression was also analyzed. Cell proliferation was measured by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay.

RESULTS

The OA cartilage contains a higher level of type I collagen, WISP1, Integrin α5, and Integrin αV, but low type II collagen. The upregulation of TGF-β1 caused the increase of WISP1, as well as the high level of Integrin α5/V, and dedifferentiated gene. Besides, the upregulation of WISP1 also contributed to the TGF-β1 expression and CHs dedifferentiation. Apart from this, the silencing of the α5 subunit of Integrin aggravated the WISP1 induced CHs dedifferentiation, which was reversed by α5 upregulation. However, the αV subunit played an opposite role that mediated the WISP1-induced CHs dedifferentiation. Additionally, the interaction between TGF-β1 and WISP1 promoted the CHs proliferation, which was not affected by the Integrin-α5/V expression.

CONCLUSIONS

TGF-β1 and WISP1 interact to induce CHs dedifferentiation, which was mainly by the mediation of the Integrin-αV subunit. On the contrary, Integrin-α5 shows a protective effect during the WISP1 caused CHs dedifferentiation.

LncRNA SNHG16 drives proliferation, migration, and invasion of lung cancer cell through modulation of miR-520/VEGF axis

OBJECTIVE

Long non-coding RNAs (lncRNAs) have been shown to have important effects on various biological behavior of human diseases. Although increasing lncRNAs have been explored in human cancers, there are still countless lncRNA to be mined. The purpose of this study was to investigate the effect of lncRNA SNHG16 on the proliferation and metastasis of lung cancer cells.

PATIENTS AND METHODS

RT-qPCR was used to analyze the expression patterns of SNHG16, miR-520 and VEGF. MTT and transwell methods were used to detect the effect of SNHG16 on cell migration. The association between SNHG16, miR-520 and VEGF was analyzed by bioinformatics analysis and Dual-Luciferase verification reporter analysis. Finally, lung cancer cells have demonstrated the role of SNHG16-miR-520-VEGF in the cell biological behavior axis.

RESULTS

Compared with normal cells, SNHG16 is highly expressed in lung cancer cells. Silent SNHG16 has a negative effect on the migration of lung cancer cells.

CONCLUSIONS

LncRNA SNHG16 as ceRNA up-regulates VEGF in lung cancer cells by binding to miR-520. LncRNA SNHG16 as ceRNA promotes the migration of lung cancer cells by regulating the miR-520/VEGF axis.

Coronary hypercontractility to acidosis owes to the greater activity of TMEM16A/ANO1 in the arterial smooth muscle cells

BACKGROUND

Severe acidosis deteriorates cardiac injury. Rat coronary arteries (RCAs) are unusually hypercontractive to extracellular (o) acidosis (EA). TMEM16A-encoded anoctamin 1 (ANO1), a Ca²⁺-activated chloride channel (CaCC), plays an important role in regulating coronary arterial tension.

PURPOSE

We tested the possibility that the activation of CaCCs in the arterial smooth muscle cell (ASMC) contributes to EA-induced RCA constriction.

METHODS

ANO1 expression was detected with immunofluorescence staining and Western blot. TMEM16A mRNA was assessed with quantitative Real-Time PCR. Cl^- currents and membrane potentials were quantified with a patch clamp. The vascular tension was recorded with a myograph. Intracellular (i) level of Cl^- and Ca²⁺ was measured with fluorescent molecular probes.

RESULTS

ANO1 was expressed in all tested arterial myocytes, but was much more abundant in RCA ASMCs as compared with ASMCs isolated from rat cerebral basilar, intrarenal and mesenteric arteries. EA reduced [Cl^-]_i levels, augmented CaCC currents exclusively in RCA ASMCs and depolarized RCA ASMCs to a greater extent. Cl^- deprivation, which depleted [Cl^-]_i by incubating the arteries or their ASMCs in Cl^--free bath solution, decreased EA-induced [Cl^-]_i reduction, diminished EA-induced CaCC augmentation and time-dependently depressed EA-induced RCA constriction. Inhibitor studies showed that these EA-induced effects including RCA constriction, CaCC current augmentation, [Cl^-]_i reduction and/or [Ca²⁺]_i elevation were depressed by various Cl^- channel blockers, [Ca²⁺]_i release inhibitors and L-type voltage-gated Ca²⁺ channel inhibitor nifedipine. ANO1 antibody attenuated all observed changes induced by EA in RCA ASMCs.

CONCLUSION

The greater activity of RCA ASMC CaCCs complicated with an enhanced Ca²⁺ mobilization from both [Ca²⁺]_i release and [Ca²⁺]_o influx plays a pivotal role in the distinctive hypercontractility of RCAs to acidosis. Translation of these findings to human beings may lead to a new conception in our understanding and treating cardiac complications in severe acidosis.

Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: A retrospective cohort study

PURPOSE

We aimed to evaluate the association of early versus late initiation of Continuous renal replacement therapy (CRRT) with mortality in patients with fluid overload.

METHODS

This was a retrospective cohort study of patients with fluid overload (FO) treated with CRRT due to severe acute kidney injury (AKI) between January 2015 and December 2017 in a mixed medical intensive care unit of a teaching hospital in Beijing, China. Patients were divided into early (≤15 h) and late (>15 h) groups based on the median time from ICU admission to CRRT initiation. The primary outcome was all-cause mortality at day 60. Multivariable Cox model analysis was used for analysis.

RESULTS

The study patients were male predominant (84/150) with a mean age of 64.8 ± 16.7 years. The median FO value before CRRT initiation was 10.1% [6.2-16.1%]. The 60-day mortality rates in the early vs the late CRRT groups were 53.9% and 73%, respectively. On multivariable Cox modelling, the late initiation of CRRT was independently associated with an increased risk of death at 60 days (HR 1.75, 95% CI 1.11-2.74, p = 0.015).

CONCLUSIONS

Early initiation of CRRT was independently associated with survival benefits in severe AKI patients with fluid overload.

Initiation and progression of dental-stimulated temporomandibular joints osteoarthritis

Temporomandibular joint (TMJ), a site that is often impacted by osteoarthritis (OA), is biomechanically linked with dental occlusion. Tissue responses in TMJ condyle to biomechanical stimulation could be investigated by intervention of the dental occlusion in animals. Unilateral anterior crossbite, an experimental malocclusion, has been demonstrated to induce TMJ-OA lesions, showing primarily as enhanced cartilage calcification and subchondral cortical bone formation at the osteochondral interface, causing the osteochondral interface thickening and stiffening. The changed interface would worsen the local biomechanical environment. At the cartilage side, the matrix degenerates. In the case of insufficient restoration of the matrix, the cells in the deep zone flow into the ones undergoing autophagy, apoptosis, and terminal differentiation while the cells in the superficial zone are promoted to differentiate to supply the loss of the deep zone cells. At the meantime, the bone marrow stromal cells are stimulated to bone formation in the subchondral cortical region which is uncoupled with the sites of the osteoclast-mediated resorption process that is predominantly observed at the subchondral trabecular bone region. Overall, the thickening and stiffening osteochondral interface, due greatly to the enhanced endochondral ossification in deep zone cartilage, should be a central pathological process that links with cartilage decay and subchondral bone remodelling in OA joints. The residual chondrocytes locating in the cartilage superficial zone have the progenitor-like qualities that can proliferate, and also differentiate into the deep zone chondrocytes, thus should be critical in progression and rehabilitation of TMJ-OA.

Computed tomography osteoabsorptiometry-based investigation on subchondral bone plate alterations in sacroiliac joint dysfunction

Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differences were found when comparing inferior sacral and iliac regions. Furthermore, HU values in the inferior sacral region were significantly higher when compared to the same region of the healthy controls (524 ± 94 vs. 447 ± 91, p < 0.01). Region mineralization correlated negatively with age (p < 0.01). SIJD-affected joints reflect a high mineralization of the sacral inferior region, suggesting increased SIJD-related mechanical stresses. Age-related SCB demineralization is present in all individuals, regardless of dysfunction.

Can perihaematomal radiomics features predict haematoma expansion?

AIM

To evaluate the association between perihaematomal radiomics features and haematoma expansion (HE).

MATERIALS AND METHODS

Clinical and radiological data were collected retrospectively. The 1:1 propensity score matching (PSM) method was used to balance the difference of baseline characteristics between patients with and without HE. Radiomics features were extracted from the intra- and perihaematomal regions. Top HE-associated features were selected using the minimum redundancy, maximum relevancy algorithm. Support vector machine models were used to predict HE. Predictive performance of radiomics features from different regions was evaluated by receiver operating characteristic curve and confusion matrix-derived metrics.

RESULTS

A total of 1,062 patients were enrolled. After PSM analysis, the propensity score-matched cohort (PSM cohort) included 314 patients (HE: n=157; non-HE: n=157). The PSM cohort was distributed into the training (n=218) and the validation cohorts (n=96). The predictive performance of intra- and perihaematomal features were comparable in the training (area under the receiver operating characteristic curve [AUC], 0.751 versus 0.757; p=0.867) and the validation cohorts (AUC, 0.724 versus 0.671; p=0.454). By incorporating intra- and perihaematomal features, the combined model outperformed the single intrahaematomal model in the training cohort (AUC, 0.872 versus 0.751; p<0.001). Decision curve analysis (DCA) further confirmed the clinical usefulness of the combined model.

CONCLUSION

Perihaematomal radiomics features can predict HE. The integration of intra- and perihaematomal signatures may provide additional benefit to the prediction of HE.

Mood and suicidality amongst cyberbullied adolescents- a cross-sectional study from youth risk behavior survey

Introduction

There is a limited literature available showing mental health burden among adolescents following cyberbullying.

Objectives

Aim is to evaluate the association of low mood and suicidality amongst cyberbullied adolescents.

Methods

A study on CDC National Youth Risk Behavior Surveillance (YRBS) (1991-2017). Responses from adolescence related to cyberbullying and suicidality were evaluated. Chi-square and mix-effect multivariable logistic regression analysis was performed to find out the association of cyberbullying with sadness/hopelessness, suicide consideration, plan, and attempts.

Results

A total of 10,463 adolescents, 14.8% of adolescents faced cyberbullying a past year. There was a higher prevalence of cyberbullying in youths aged 15-17 years (25 vs 26 vs 23%), which included more females to males (68 vs 32%).(p<0.0001) Caucasians (53%) had the highest number of responses to being cyberbullied compared to Hispanics (24%), African Americans (11%).(p<0.0001) There was an increased prevalence of cyberbullied youths with feelings of sadness/hopelessness (59.6 vs 25.8%), higher numbers considering suicide (40.4 vs 13.2%), suicide plan (33.2 vs 10.8%), and multiple suicidal attempts in comparison to non-cyberbullied.(p<0.0001) On regression analysis, cyberbullied adolescence had a 155% higher chance of feeling sad and hopeless [aOR=2.55; 95%CI=2.39-2.72], considered suicide [1.52 (1.39-1.66)], and suicide plan [1.24 (1.13-1.36)].

Conclusions

In our study, cyberbullying was associated with negative mental health outcomes. Further research is warranted to examine the impact and outcomes of cyberbullying amongst adolescents and guiding the policies to mitigate the consequences.

Disclosure

No significant relationships.