THU0427 SHOULD FEBUXOSTAT-RESISTANCE BE ADDED TO CRITERIA FOR REFRACTORY GOUT? A PRELIMINARY STUDY

Background:

Refractory gout manifests as recurrent flares, chronic arthritis and progressive tophaceous deposits. Febuxostat is a widely-used potent serum urate-lowering reagent, but some gout patients cannot achieve target serum uric acid (sUA) after they used this reagent.

Objectives:

To determine whether febuxostat-resistance should be a criterion for refractory gout, characteristics of gout patients who were resistance to febuxostat or allopurinol were compared.

Methods:

This study was performed from December 2015 to December 2019. Medical records of gout patients who met the 2015 gout classification criteria [1] and undertook febuxostat (febuxostat group) or allopurinol (allopurinol group) urate-lowing therapy (ULT) were assessed. Dose of ULT was adjusted till sUA was below 6 mg/dL and 5 mg/dL for patients with urate deposition. We screened gout patients who had contraindication or history of failure to normalize sUA for≥ 3 months of treatment with the maximum medically appropriate febuxostat (febuxostat-resistance) or allopurinol (allopurinol-resistance) dose as defined by physicians. Furthermore, these screened patients met the traditional criteria of refractory gout except therapeutic reaction [2].Demography and clinical characteristics were recorded. Features between febuxostat-resistance and allopurinol-resistance patients were compared.

Results:

(1) Of 683 gout patients who were included, 516 and 167 of them used febuxostat or allopurinol. (2) Age (41.92±11.58 vs. 42.26±9.41 years), Male gender (97.50% vs. 97.01%), duration of gout (5.78±4.74 vs. 5.05±4.72 years) and sUA (6.30±2.50 vs. 6.67±2.14 mg/dL) were similar between febuxostat group and allopurinol group (P>0.05). (3) Dose of febuxostat or allopurinol were 47.28mg/day and 178.24mg/day. (4) Sixteen patients were febuxostat-resistance, while 6 patients were allopurinol-resistance. Prevalence rates of treatment resistance were comparable between groups (3.10% vs. 3.59%,P>0.05). (5) Some parameters were different between resistance patients and non-resistance patients in both groups (Table 1,P<0.05). However, characteristics of febuxostat-resistance and allopurinol-resistance patients were similar (P>0.05).

Table 1

Characteristics of gout patients in febuxostat group and allopurinol group

ParametersFebuxostat GroupAllopurinol GroupNon-resistance(n=500)Resistance(n=16)Non-resistance(n=161)Resistance(n=6)Age (year)41.93±11.6541.67±9.5842.22±13.3344.50±16.98Male Gender (%)97.40100.0096.89100.00BMI (kg/m2)25.44±3.4626.22±3.4725.86±3.9725.60±6.42Duration of gout (years)5.75±4.767.00±3.97*4.96±4.737.75±2.62*Flares in previous 18 months (times)1.31±0.443.67±0.70*1.13±0.243.25±0.50*Presence of Tophi (%)23.80100.00*14.90100.00*Presence of Complication (%)35.8100.00*31.06100.00*sUA (mg/dL)6.21±2.479.13±1.24*6.42±2.3210.15±3.55*SCr (μmol/L)100.67±15.03163.96±29.41*96.93±22.91133.75±31.60*ESR (mm/L)24.59±19.2842.83±21.13*27.49±24.1056.50±28.12*CRP (mg/L)18.92±18.5928.81±23.85*23.12±22.6332.28±23.64*

*P<0.05 compared with non-resistance patients in the same group.

BMIbody mass index,sUAserum uric acid,SCrserum creatinine,ESRerythrocyte sedimentation rate,CRPC-reactive protein

Conclusion:

Febuxostat-resistance is a potential criterion for refractory gout, because febuxostat-resistance patients shares similar characteristics of patients with refractory gout.

References:

[1]Neogi T, Jansen TL, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015;74(10):1789-1798.

[2]Lawrence Edwards N, Singh JA, Troum O, et al. Characterization of patients with chronic refractory gout who do and do not have clinically apparent tophi and their response to pegloticase. Rheumatology (Oxford) 2019; pii: kez017.

Acknowledgments:

None.

Disclosure of Interests: :

None declared

AB0931 THE QUALITY OF LIFE IN GOUT PATIENTS WITH ULCERATION OVER TOPHI

Background:

The prevalence of gouty patients with ulcerations over tophi are increasing over time and it has been reported that gouty patients have significantly poor quality of life (QoL) compared to those healthy controls. [1, 2] there is no study on comparison of the QoL in patients with or without ulceration over tophi.

Objectives:

To compare the QoL in gout patients with or without ulcerations over tophi.

Methods:

A total of 79 inpatients with gout who were admitted to Guangdong Second Provincial General Hospital from January 2019 to January 2020 were included. Among them, ulcerations were identified in 28 patients. Short Form-36 Scales (SF-36) were chosen to assess patients. Differences between the groups were tested with Student’s t test or Mann-Whitney U test for continuous variables, and Chi-square tests for categorical variables.

Results:

Of 79 subjects, 74 were male, mean age was 54.23±14.3 years, disease duration was 10.94±7.06 years. Gouty patients had moderate- to high-quality levels in general health, vitality, social functioning, role emotional, and mental health (median: 65, 75, 75, 88, and88, respectively), while had low levels of quality in role physical, and bodily pain (median: 0, and 22, respectively). Patients presenting with ulcerations over tophi had worse scores on five SF-36 domains, the mental component summary (MCS) and the physical component summary (PCS) than gout patients without ulcerations [mean (SD); P < 0.05 for all]: Bodily pain, 30.86(31.59) vs 35.17(33.40); General health, 49.46(27.01) vs 64.17(23.69); Vitality, 57.14(32.53) vs 72.84(26.38); Mental health, 75.4(22.43) vs 83.05(20.96); Reported health transition, 3.58(0.89) vs 3.78(1.42); MCS, 52.62(21.82) vs 66.65(21.44); PCS, 35.85(21.17) vs 46.67(23.86).

Conclusion:

Patients with ulcerations over tophi present much worse QoL compared those without ulcerations. Our study suggests that the presence of ulceration over tophi further deteriorates the QoL in gout patients.

References:

[1]Z. Huang, X. Liu, Y. Liu, et al., Clinical characteristics and risk factors of ulceration over tophi in patients with gout, Int J Rheum Dis, 22 (2019) 1052-1057.

[2]T. Fu, H. Cao, R. Yin, et al., Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study, BMC Musculoskelet Disord, 18 (2017) 429.

Table 1.

Clinical characteristics

VariableTotal (n=79)Non-ulcerations (n=51)Ulcerations (n=28)PvalueMale, n (%)74(93.7)47(92.1)27(96.4)0.462Agea, mean, y54.23±14.3053.96±12.2454.71±17.690.842Body mass indexa, kg/m224.87±3.9725.13±4.0224.40±3.910.444Gout durationa,y10.96±7.0610.04±6.7512.63±7.410.119Maximum Serum uric acid, mg/dL625.5±133.86630.9±124.23614.3±166.430.639Smoking, n (%)38(48.1)23(45.1)15(53.5)0.477Alcohol, n (%)26(32.9)13(25.5)13(46.4)0.072Hypertension, n (%)34(43.0)18(35.3)16(57.1)0.062Diabetes mellitus, n (%)13(16.5)10(19.6)3(10.7)0.281Regular treatment, n(%)3(3.8)3(5.9)0(0)0.971Glucocorticoid abuse, n (%)18(22.8)11(21.5)7(25.0)0.173

aMean (SD).

Table 2.

QoL scores

Median (IQR)Non-ulcerations (n=51), mean (SD)Ulcerations (n=28), mean (SD)PvaluePhysical functionb50(20-80)58.62(32.17)40.89(35.97)0.095Role physicalb0 (0-100)33.03(46.91)17.85(37.17)0.119Bodily painb22(0-62)35.17(33.40)30.86(31.59)0.007General healthb65 (40-80)64.17(23.69)49.46(27.01)0.014Vitalityb75 (50-95)72.84(26.38)57.14(32.53)0.023Social functionb75(38-100)72.55(3.02)60.27(33.85)0.107Role emotionalb88 (68-96)33.98(47.37)15.43(34.45)0.135Mental healthb88 (68-96)83.05(20.96)75.4(22.43)0.007Reported health transition3.78(1.42)3.58(0.89)0.007PCS46.67(23.86)35.85(21.17)0.048MCS66.65(21.44)52.62(21.82)0.007

b(range = 0-100)

Disclosure of Interests:

None declared

THU0450 OPTIMISTIC STATUS ASSOCIATES WITH COMPLIANCE TO URATE-LOWERING THERAPY IN GOUT PATIENTS

Background:

Compliance to urate-lowering therapy (ULT) is poor in gout patients, which contributes to increased frequency of acute gout attacks, deposition of tophi and urate nephropathy [1]. Optimistic status is probably a potential and considerable factor affecting compliance to ULT in gout patients.

Objectives:

To compare optimistic status between gout patients and healthy controls, and also between gout patients with good and poor compliance. Relationship between optimistic status and compliance to ULT, sUA target achievement of gout patients were assessed as well.

Methods:

This was a monocentric and observational study which was performed from August 2018 to December 2019. Adult patients who met the 2015 gout classification criteria were included in this study. The healthy controls were individuals who were free of gout, hyperuricemia and other rheumatic diseases from the physical examination center of our hospital. Demographic data, including age, gender and education were collected from all individuals. Serum uric acid (sUA) were collected from gout patients at enrollment and again after 3 months. Disease duration of gout, visual analogue scale (VAS) of pain were also assessed for gout patients at enrollment. Compliance to ULT was measured using the medication possession ratio (MPR) in the following 3 months. Poor compliance was defined as MPR<0.8 and good compliance was defined as MPR≥0.8. All subjects completed the life orientation test-revised (LOT-R) for optimistic status assessment.

Results:

Five hundred and thirty gout patients and 307 healthy controls matched by age (41.4±12.3 vs. 42.1±9.3 years), gender (male 97.1% vs. 95.1%) and education (college graduated 54.2% vs. 58.0%) were included in this study. Of the 530 gout patients, the mean disease duration was 5.7±4.9 years, and 292 (55.1%) patients’ MPR were lower than 0.8. There was no statistic difference in LOT-R between gout patients and healthy controls (19.0±2.4 vs. 19.2±2.5, P>0.05) (Table 1). Gout patients with poor compliance (MPR<0.8) had higher level of sUA (525.5±138.0 vs. 471.2±152.5 μmol/L, P<0.05), followup sUA (450.1±154.5 vs. 361.6±120.0 μmol/L, P<0.05) and higher LOT-R (19.6±2.6 vs. 17.8±1.7, P<0.05) than those with good compliance (MPR≥0.8). Of the 292 gout patients with poor compliance, there were only 83 (28.4%) patients achieved sUA target after 3 months, and their LOT-R were significantly lower than those did not achieve sUA target (18.8±2.1 vs. 19.6±2.4, P<0.05). Finally, LOT-R correlated positively with sUA (r=0.131, P<0.05) and followup sUA (r=0.09, P<0.05), but negatively with MPR (r=-0.473, P<0.05) of gout patients (Table 2).

Table 1

Demographic and optimistic status of gout patients and healthy controls

VariablesGout patients(n=530)Controls(n=307)PAge (years)41.4±12.342.1±9.30.116Male gender, n (%)511 (96.4)292 (95.1)0.368College graduated, n (%)287 (54.2)178 (58.0)0.312LOT-R19.0±2.419.2±2.50.189

LOT-R:life orientation test-revised

Table 2

Correlation analysis between LOT-R and clinical variables in gout patients

VariablesLOT-RrPAge00.994Disease duration-0.0580.182VAS0.0340.432sUA0.1310.003*Followup sUA0.1260.016*MPR-0.393<0.001*

LOT-R: life orientation test-revised,VAS:visual analogue scale,sUA:serum uric acid,MPR:medication possession ratio

*P<0.05

Conclusion:

Gout patients share similar optimistic status to healthy controls. However, optimistic status relates to compliance to ULT and sUA target achievement of gout patients.

References:

[1]Harrold L R, Andrade S E, Briesacher B A, et al. Adherence with urate-lowering therapies for the treatment of gout. Arthritis research & therapy 2009, 11(2):R46.

Disclosure of Interests: :

None declared

0005 Cataplexy Triggered by Social Cues: A Role for Oxytocin in the Amygdala

Introduction

People with narcolepsy type 1 report that cataplexy is triggered most often by positive social experiences such as laughing with friends, yet the mechanisms through which social interaction promotes cataplexy are unknown. We hypothesize a subpopulation of central amygdala neurons that are sensitive to the prosocial neuropeptide, oxytocin (CeAOTR), respond to positive valence and trigger cataplexy.

Methods

We have used in vivo calcium imaging, chemogenetic and optogenetic approaches to characterize the activity pattern of these neurons and to manipulate their activity state.

Results

Cre-dependent anterograde tracing of the CeAOTR neurons of the central amygdala indicate a moderate to dense projection to the REM sleep-regulatory region of the ventral lateral periaqueductal gray (vlPAG). Additionally, Channel Rhodopsin Assisted Circuit Mapping (CRACM) experiments show that CeAOTR neurons inhibit vlPAG neurons that innervate the REM atonia-promoting region, the sublaterodorsal nucleus. Targeted photostimulation (15Hz (10ms) for 20sec every hour) of the CeAOTR fibers in the vlPAG doubled the amount of cataplexy. Preliminary in vivo calcium imaging indicates that the CeAOTR are active just prior to the onset of cataplexy. Chemogenetic and optogenetic activation of CeAOTR neurons increased cataplexy.

Conclusion

We conclude that the CeAOTR subpopulation is sufficient to promote cataplexy. Our future directions include determining the necessity of these oxytocin sensitive neurons in cataplexy under different conditions of positive valence.

Support

R01 NS106032 and WakeUp Narcolepsy.

Cathodoluminescent screen imaging system for seeded blob detection in toroidal plasma experiment

We designed and built a diagnostic based on a cathodoluminescent screen for the detection of turbulent plasma structures with high spatial resolution. The screen is coated with a low threshold energy cathodoluminescent powder that emits light when exposed to a plasma. The emitted light is imaged with a fast frame camera combined with an image intensifier and an optical bandpass filter. The diagnostic is used to study turbulent structures and seeded blobs. The results are analyzed with pattern recognition algorithms to track the turbulent structures and study their evolution in time.

Spin structure relation to phase contrast imaging of isolated magnetic Bloch and Néel skyrmions

Magnetic skyrmions are promising candidates for future storage devices with a large data density. A great variety of materials have been found that host skyrmions up to the room-temperature regime. Lorentz microscopy, usually performed in a transmission electron microscope (TEM), is one of the most important tools for characterizing skyrmion samples in real space. Using numerical calculations, this work relates the phase contrast in a TEM to the actual magnetization profile of an isolated Néel or Bloch skyrmion, the two most common skyrmion types. Within the framework of the used skyrmion model, the results are independent of skyrmion size and wall width and scale with sample thickness for purely magnetic specimens. Simple rules are provided to extract the actual skyrmion configuration of pure Bloch or Néel skyrmions without the need of simulations. Furthermore, first differential phase contrast (DPC) measurements on Néel skyrmions that meet experimental expectations are presented and showcase the described principles. The work is relevant for material sciences where it enables the engineering of skyrmion profiles via convenient characterization.

[Effects of ticagrelor on cardiorespiratory fitness in patients after percutaneous coronary intervention]

Objective: To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods: A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. Results: In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all P>0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), P<0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all P>0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (OR=1.098, 95%CI 1.032-1.168, P=0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all P>0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all P>0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (OR=1.132, 95%CI 1.030-1.244, P=0.010). Conclusion: Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.

[Progress of antiviral therapy for hepatitis C virus-related decompensated cirrhosis]

Direct-acting antiviral agents (DAAs) are the main antiviral therapeutics for hepatitis C virus-related decompensated stage cirrhosis. DAAs of NS3/4A protease inhibitors use is not recommended for patients with decompensated cirrhosis due to characteristics of DAAs metabolism in liver. The recent guidelines have recommended sofosbuvir (SOF)-based plan including pan-genotype plan of sofosbuvir(SOF)/velpatasvir (VEL), sofosbuvir combined with daclatasvir (DCV), genotype 1,4,5,6 specific plan of sofosbuvir (SOF) / ledipasvir (LDV) for 24 weeks or above in combination with ribavirin for 12 weeks because NS5B and NS5A inhibitors has no obvious effect on CYP450 enzyme system and achievement of sustained virological response (SVR) rates at 12/24 weeks is achievable in 88% ~ 100%, and liver reserve function improves in 42% ~ 53% of patients. Furthermore, approximately 15.5% ~ 49% of patients waiting for liver transplantation after treatment with DAAs do not require liver transplantation for short-term and 10.3% ~19.2% of patients receiving SOF/LDV, and SOF combined with DCV not needed liver transplantation. Thus, the clinical application of DAAs provides a safe and reliable antiviral treatment plan for hepatitis C virus-related decompensated stage cirrhosis.

Comprehensive molecular characterization of inhibitors of apoptosis proteins (IAPs) for therapeutic targeting in cancer

Background

Inhibitors of apoptosis proteins (IAPs) are a family of antiapoptotic proteins modulating cell cycle, signal transduction and apoptosis. Dysregulated IAPs have been reported to contribute to tumor progression and chemoresistance in various cancers. However, existing studies were sporadic and only focus on one specific cancer with one particular gene in the IAPs family. A systematic investigation on the co-expression pattern, regulation frameworks on various pathways, prognostic utility on patient outcomes, and predictive value on drug sensitivity among all the IAPs across multiple tumor types was lacking.

Methods

Leveraging The Cancer Genome Atlas data with comprehensive genomic characterizations on 9714 patients across 32 tumor types and the Genomics of Drug Sensitivity in Cancer data with both genomic characterizations and drug sensitivity data on > 1000 cell lines, we investigated the co-expression pattern of IAPs, their regulations of apoptosis as well as other pathways and clinical relevance of IAPs for therapeutics development.

Results

We discovered diverse expression pattern among IAPs, varied spectrum of apoptosis regulations through IAPs and extensive regulations beyond apoptosis involving immune response, cell cycle, gene expression and DNA damage repair. Importantly, IAPs were strong prognostic factors for patient survival and tumor stage in several tumor types including brain, liver, kidney, breast and lung cancer. Further, several IAPs were found to be predictive of sensitivity to BCL-2 inhibitors (BIRC3, BIRC5, BIRC6, and BIRC7) as well as RIPK1 inhibitors (BIRC3 and BIRC6).

Conclusion

Together, our work revealed the landscape of regulations, prognostic utilities and therapeutic relevance of IAPs across multiple tumor types.

Sensory Impairment and All-Cause Mortality Among the Oldest-Old: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVES

To investigate the association between sensory impairment and all-cause mortality among the oldest-old (aged 80 and older) in China.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

A total of 8788 older adults aged 80 and over at baseline with complete hearing and vision function data were included as the study population.

MEASUREMENTS

Sensory impairment was categorized as no sensory impairment, hearing impairment (HI) only, vision impairment (VI) only and dual sensory impairment (DSI) according to hearing and vision function. Deaths were identified through interviews by close family members. Cox proportion hazards regression models were used to examine the association of sensory impairment with mortality, adjusting for socio-demographic data, life style factors and health status.

RESULTS

The mean age was 92.3 ± 7.6 years old, and 60.1% of participants were female. Among 8788 participants, 9.8% were recognized as DSI, 9.7% were HI only and 10.4% with VI only. Comparing with participants with no sensory impairment, those with VI only (HR=1.10, 95% CI=1.01-1.20) and DSI (HR=1.21, 95% CI=1.09-1.35) were significantly associated with higher risk of all-cause mortality in the fully adjusted model.

CONCLUSION

Our results demonstrated that VI only and DSI were significantly associated with higher risk of mortality among Chinese older adults aged 80 and over. The finding advocated that it is necessary to identify and manage sensory impairments for the advanced ages to reduce mortality risks.

Ethnic Groups Differences in the Prevalence of Sarcopenia Using the AWGS Criteria

OBJECTIVES

To estimate the prevalence of sarcopenia in different ethnic groups and the association with cultural life styles in west China.

DESIGN

A cross-sectional study.

SETTINGS

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

4500 participants aged 50 years or older in west China were enrolled in this study. Sarcopenia was defined according to the diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS).

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants. Life-style information were collected by reviewers. Relationships between sarcopenia and ethnic groups were analyzed using univariate and multivariate analyses.

RESULTS

We found 869 (19.31%) adults aged 50 years old or older were sarcopenia. The mean age is 62.4±8.3 years. The main ethnic groups enrolled in this study is Han, Tibetan, Qiang, Yi and Hui. The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Compared to Han, after adjusting sex and age, Qiang has a lower prevalence of sarcopenia (odds ratio [OR]: 0.44, 95% CI 0.35-0.55), Yi has a higher prevalence of sarcopenia (OR: 1.78, 95% CI 1.29-2.43). While adding adjusting other potential cofounders, sarcopenia is still less prevalent in Qiang (OR: 0.44, 95% CI 0.34-0.57).

CONCLUSIONS

The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Sarcopenia was less prevalent in Qiang compared with Han. Further studies to determine related factors of sarcopenia among different ethnic groups are recommended.

Association Between Number of Teeth, Denture Use and Frailty: Findings from the West China Health and Aging Trend Study

OBJECTIVE

Frailty and poor oral health are both common age-related conditions. However, the association between oral health and frailty has not been explored thoroughly among older Chinese adults. We aimed to investigate the associations between number of teeth, denture use, and frailty among older adults in western China.

DESIGN

Cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

Participants were 4037 community-dwelling individuals aged 60 and older from the West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

Frailty was assessed using the physical frailty phenotype (PFP) and categorized as non-frail, prefrail and frail. In addition, number of teeth and denture use were examined by calibrated dentists. Multinomial logistic regression models were performed to examine the association between number of teeth, denture use, and frailty.

RESULTS

The overall prevalence of frailty was 6.7% among 4037 participants aged 60 and older in western China. Participants with no more than 20 teeth were associated with higher odds of being prefrail or frail whether wearing dentures or not. Denture using could not help lower the odds of being prefrail or frail for older adults with fewer teeth.

CONCLUSIONS

This study suggested that frailty was associated with having fewer teeth (≤20 teeth) among older Chinese adults. Future research involving targeted interventions addressing number of teeth may help provide information to establish effective strategies for frailty prevention in older adults.

Sarcopenia, Obesity and Sarcopenia Obesity in Comparison: Prevalence, Metabolic Profile, and Key Differences: Results from WCHAT Study

OBJECTIVE

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects with non-sarcopenia/non-obesity (H), sarcopenia/non-obesity (S), non-sarcopenia/obesity (O) and sarcopenia obesity (SO) in a multi-ethnic population in west China.

DESIGN

A cross-sectional study.

SETTING

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4,500 participants aged 50 years or older who did bioelectrical impedance in our analysis from West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all participants. We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). Obesity was defined as the highest sex-specific quintile of the percentage body fat. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences of metabolic profiles among different groups.

RESULTS

Of 4500 participants aged 50 years old or older, the proportions of H, O, S, SO were 63.0%, 17.7%, 16.7% and 2.6%, respectively. And the prevalence of S subjects in men was 18.3% and 15.7% in women, while the prevalence of SO was 3.7% in men and 2.0% in women. Data showed that the prevalence of S and SO has an aging increase pattern which was opposite with O. Both S and SO tends to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S seems to be worse than SO. Compared to H, S cohort showed a decrease in Vitamin D, triglyceride, albumin, fasting glucose, insulin, creatinine, ALT, nutrition scores and increase in HDL. SO cohort were observed for an increase in cholesterol, LDL, total protein and decrease in vitamin D. While O cohort showed an increase in triglyceride, cholesterol, LDL, total protein, glucose, insulin, WBC, uric acid, ALT and nutrition scores, but a decrease in HDL and vitamin D level.

CONCLUSIONS

Among individuals aged 50 years old or older in West China. S, O and SO participants demonstrate distinct differences in the life-styles, chronic disease profile, and metabolic profiles. The prevalence of S and SO has an aging increase pattern contrary to O. Both S and SO tend to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S looks like to be worse than SO. Besides, the S subjects seem to have more metabolic index changes than SO compared to H. While O subjects have some contrary metabolic index to S subjects.

Prevalence and Its Associated Factors of Physical Frailty and Cognitive Impairment: Findings from the West China Health and Aging Trend Study (WCHAT)

OBJECTIVES

Previous literature has reported that physical frailty (PF) closely associated with cognitive impairment (CI). In this study, we aim to describe and evaluate the prevalence and associated factors with different patterns of PF and cognitive impairment.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Community-dwelling older adults aged ≥60 from the West China Health and Aging Trend (WCHAT) study were included in this study.

MEASUREMENTS

Participants were assessed the PF and cognitive impairment. PF was assessed using the physical phenotype as defined by Fried's criteria. Cognitive impairment was identified using the Short Portable Mental Status Questionnaire (SPMSQ). According different patterns of PF and cognitive impairment, participants were divided into 4 groups: not-PF and cognitive intact ( "neither" group), not-PF and cognitive impairment ("CI only" group), PF and cognitive intact ("PF only" group), and PF and cognitive impairment ("both" group). Multinomial logistic regression was used to explore the association between medical conditions and different patterns of PF and cognitive impairment after adjusting the demographic characteristics.

RESULTS

Among 4,103 participants (age 67.8 + 5.9 years, female 58.3%), 78.8%, 3.9%, 14.5% and 2.9% were "neither", "PF only", "CI only", and "both", respectively. The prevalence of "PF only", "CI only" and "both" were associated with age, lower education level and single status. In addition, there was substantial ethnicity heterogeneity in the prevalence of different patterns of PF and cognitive impairment. Comparing with "neither", PF and/or cognitive impairment had higher association with depression, ADLs impairment, and malnutrition. Of note, obesity was only significantly associated with "PF only", but not associated with "CI only" or "both".

CONCLUSIONS

We found the substantial demographic and medical conditions disparities in different patterns of PF and cognitive impairment. Further research should focus on the efficient and practical screen to predict the risk of "PF only", "CI only" and "both".

Direct investigation of current transport in cells by conductive atomic force microscopy

Currents play critical roles in neurons. Direct observation of current flows in cells at nanometre dimensions and picoampere current resolution is still a daunting task. In this study, we investigated the current flows in hippocampal neurons, PC12 cells and astrocytes in response to voltages applied to the cell membranes using conductive atomic force microscopy (CAFM). The spines in the hippocampal neurons play crucial roles in nerve signal transfer. When the applied voltage was greater than 7.2 V, PC12 cells even show metallic nanowire-like characteristics. Both the cell body and glial filaments of astrocytes yielded CAFM test results that reflect different electrical conductance. To our best knowledge, the electrical characteristics and current transport through components of cells (especially neurons) in response to an applied external voltage have been revealed for the first time at nanometre dimensions and picoampere current levels. We believe that such studies will pave new ways to study and model the electrical characteristics and physiological behaviours in cells and other biological samples.

Cisplatin-mediated down-regulation of miR-145 contributes to up-regulation of PD-L1 via the c-Myc transcription factor in cisplatin-resistant ovarian carcinoma cells

Immune tolerance is one of the leading causes of chemotherapy resistance in carcinoma cases. Studies have shown that programmed cell death ligand-1 (PD-L1), an inhibitory molecule expressed by cancer cells, plays a significant role in immune tolerance through the induction of T cell dysfunction. The results of our RNA sequencing in previous studies revealed that microRNA-145 (miR-145), which is known to be down-regulated by cisplatin in cisplatin-resistant ovarian cancer cells, also represses gene PD-L1 expression. However, the mechanism by which miR-145 contributes to regulate PD-L1 expression in cisplatin resistance of ovarian cancer is yet to be fully understood. Here, we show that cisplatin-mediated miR-145 down-regulation increased PD-L1 expression via targeting the c-Myc transcription factor, thereby inducing T cell apoptosis in vitro. We also report that expression of miR-145 is negatively correlated with PD-L1 expression in human ovarian cancer tissues, malignant grades and the recurrent risks of ovarian cancer after chemotherapy. In summary, our findings suggest that the miR-145/c-Myc/PD-L1 axis contributes to cisplatin resistance in ovarian cancer and support that miR-145 might act as an adjuvant therapeutic target in chemotherapy of ovarian cancer.

[Clinical characteristics and prognosis of high-risk neuroblastoma with bone marrow metastasis in children]

Objective: To analyze the clinical characteristics of newly treated high-risk group neuroblastoma (NB) patients with bone marrow metastasis and to explore the prognostic factors. Methods: The clinical features (sex, age, stage, risk group, pathological type, metastatic site, etc.) of 203 newly treated high-risk NB patients with bone marrow metastasis admitted to Hematology Oncology Center, Beijing Children's Hospital from January 2007 to December 2016 were analyzed retrospectively. There were 118 males (58.1%) and 85 females (41.9%). Kaplan-Meier method was used for survival analysis and Cox regression was used to analyze the prognostic factors. Results: The age at onset of the 203 patients was 41 months (9-147 months). The metastatic sites at diagnosis were as follows: bone in 195 cases (96.1%), distant lymph nodes in 104 cases (51.2%), skull and endomeninx in 61 cases (30.0%), orbit in 30 cases (14.8%), pleura in 16 cases (7.9%), liver in 13 cases(6.4%), canalis spinalis in 13 cases (6.4%), other sites in 11 cases (5.4%) and skin and soft tissue in 10 cases (4.9%). In all, 194 cases were enrolled for prognostic analysis. The follow-up time was 36 months (1 day-138 months) , and the 5-years event free survival (EFS) and overall survival (OS) were 36.1% and 39.7%, respectively. A total of 118 patients (60.8%) had events (first relapse or death) with the time to event occurrence was 15 months (1 day-72 months), whereas 112 patients (57.7%) died with the event occurrence to death time was 3 months (1 day-21 months). There was no significant difference in 5-years OS between radiotherapy group and non-radiotherapy group (42.3% vs. 38.3%, χ(2)=3.671, P=0.055). The 5-years OS in transplantation group was significantly better than the non-transplantation group (44.3% vs. 35.5%, χ(2)=8.878, P=0.003), and the radiotherapy combined transplantation group also had a better 5-years OS rate than the non-radiotherapy combined transplantation group (45.8% vs. 37.3%, χ(2)=5.945, P=0.015). Univariate survival analysis showed lactate dehydrogenase ≥ 1 500 U/L, the amplification of MYCN, the metastatic sites of orbit, canalis spinalis and pleura were associated with poor prognosis of newly diagnosed high-risk NB patients (χ(2)=21.064, 13.601, 3.998, 6.183, 15.307, all P<0.05). The amplification of MYCN and the metastatic sites of pleura were risk factors for prognosis of newly diagnosed high-risk NB patients by Cox regression models (HR=1.896,1.100, 95%CI: 1.113-3.231, 1.020-1.187, both P<0.05). Conclusions: The prognosis is unfavorable in high-risk group NB patients with BM metastasis. Radiotherapy combined with transplantation can further improve the prognosis of these patients. The amplification of MYCN and the metastatic sites of pleura were the poor prognostic factors for high-risk NB patients with bone marrow metastasis.

[Protein expressions of matrix metalloproteinase-9 and its inhibitor and their ratio changes in wound healing of patients with stages Ⅲ and Ⅳ pressure ulcers]

Objective: To explore the expression levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein and the change of MMP-9/TIMP-1 ratio in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers during wound healing. Methods: From July 2017 to July 2018, 30 patients with stage Ⅲ pressure ulcers [30 wounds, 16 males and 14 females, aged (65±10) years] and 34 patients with stage Ⅳ pressure ulcers [50 wounds, 17 males and 17 females, aged (65±9) years] admitted to Hebei General Hospital who met the inclusion criteria were enrolled in this prospective cohort study. According to the principle of wound treatment and the characteristics and needs of wound in different periods, individualized intervention measures were formulated for patients and appropriate dressings were selected. At the time of admission and on 7, 14, 21, 28 days of treatment, the healing of pressure ulcer wounds was evaluated by Pressure Ulcer Healing Scale. Afterwards, the wound exudate was collected at each time point to detect the expression levels of MMP-9 and TIMP-1 protein by enzyme-linked immunosorbent assay, and the MMP-9/TIMP-1 ratio was calculated. Data were processed with analysis of variance for repeated measurements of single group and linear trend test. Results: (1) There were significantly statistical differences in wound healing scores of patients with stages Ⅲ and Ⅳ pressure ulcers among the time of admission and on 7, 14, 21, 28 days of treatment within each stage (F=145.382, 153.234, P<0.01), and they all showed a gradually decreasing trend (F=170.466, 284.585, P<0.01). (2) At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of MMP-9 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (171±104), (138±88), (110±70), (85±55), (62±41) ng/L and (193±107), (173±104), (139±83), (114±70), (89±56) ng/L, respectively. There were significantly statistical differences within each stage (F=58.007, 111.680, P<0.01), and they all showed a gradually decreasing trend (F=62.901, 134.628, P<0.01). At the time of admission and on 7, 14, 21, 28 days of treatment, the expression levels of TIMP-1 protein in wound exudates of patients with stages Ⅲ and Ⅳ pressure ulcers were (6.2±3.9), (5.6±3.4), (5.1±3.1), (4.4±2.5), (3.8±2.3) ng/L and (4.8±2.5), (4.7±2.6), (4.4±2.6), (4.6±2.7), (4.1±2.4) ng/L, respectively. There were significantly statistical differences within each stage (F=25.479, 7.778, P<0.01), and there was a gradually decreasing trend in stage Ⅲ (F=62.901, P<0.01) and a decreasing trend in stage Ⅳ (F=134.628, P<0.01). At the time of admission, the expression levels of MMP-9 and TIMP-1 in wound exudates of patients with stage Ⅲ pressure ulcers were similar to those of patients with stage Ⅳ pressure ulcers (t=-1.03, 1.47, P>0.05). (3) At the time of admission and on 7, 14, 21, 28 days of treatment, the MMP-9/TIMP-1 ratios in the wound exudates of patients with pressure ulcers of stages Ⅲ and Ⅳ were 30±13, 25±9, 22±9, 20±8, 17±6 and 43±19, 37±13, 32±10, 26±9, 22±9, respectively. There were significantly statistical differences within each stage (F=37.173, 97.191, P<0.01), and they all showed a gradually decreasing trend (F=54.183, 130.088, P<0.01). At the time of admission, the MMP-9/TIMP-1 ratio in wound exudates of patients with stage Ⅳ pressure ulcers was significantly higher than that of patients with stage Ⅲ pressure ulcers (t=-3.42, P<0.01). Conclusions: During the wound healing process of patients with stages Ⅲ and Ⅳ pressure ulcers, the expression levels of MMP-9 and TIMP-1 protein and the MMP-9/TIMP-1 ratio in wound exudates show a decreasing trend. The stage of wound healing can be predicted according to the expression level of MMP-9 protein and the MMP-9/TIMP-1 ratio.

Topical Application of a Mast Cell Stabilizer Improves Impaired Diabetic Wound Healing

Impaired wound healing in the diabetic foot is a major problem often leading to amputation. Mast cells have been shown to regulate wound healing in diabetes. We developed an indole-carboxamide type mast cell stabilizer, MCS-01, which proved to be an effective mast cell degranulation inhibitor in vitro and can be delivered topically for prolonged periods through controlled release by specifically designed alginate bandages. In diabetic mice, both pre- and post-wounding, topical MCS-01 application accelerated wound healing comparable to that achieved with systemic mast cell stabilization. Moreover, MCS-01 altered the macrophage phenotype, promoting classically activated polarization. Bulk transcriptome analysis from wounds treated with MCS-01 or placebo showed that MCS-01 significantly modulated the mRNA and microRNA profile of diabetic wounds, stimulated upregulation of pathways linked to acute inflammation and immune cell migration, and activated the NF-κB complex along with other master regulators of inflammation. Single-cell RNA sequencing analysis of 6,154 cells from wounded and unwounded mouse skin revealed that MCS-01 primarily altered the gene expression of mast cells, monocytes, and keratinocytes. Taken together, these findings offer insights into the process of diabetic wound healing and suggest topical mast cell stabilization as a potentially successful treatment for diabetic foot ulceration.

[Endoscopic transpterygoid intervention for lesions of lateral recess of sphenoid sinus in 4 cases(with literature review) ]

Objective: To investigate the anatomy and application of endoscopic transpterygoid intervention in lesions of lateral recess of sphenoid sinus(LRSS). Method: Four hospitalized patients with lesions of LRSS were studied. The clinical presentations included spontaneous cerebrospinal fuild(CSF) leakage in 2 cases, meningoencephaolece complicated CSF leakage in 1 case and chronic invasive fungal sphenoid sinusitis invading the base of the middle fossa in 1 case. Endoscopic transpterygoid intervention and repairment of skull base defects were performed under general anesthesia. Result: he operations were successfu1 in all patients. One patient suffered from postoperative palatal hypesthesia and all the symptoms mentioned above relieved gradually 6 months after operation. No recurrence was found during the follow-up ranging from 6 to 45 months(mean follow-up period,22.75 months).Conclusion: Endoscopic transpterygoid intervention in lesions of LRSS is a minimally invasive and safe surgical approach.