Future sea level rise exacerbates compound floods induced by rainstorm and storm tide during super typhoon events: A case study from Zhuhai, China

Compound floods are becoming a growing threat in coastal cities against a background of global sea level rise (SLR), and may cause increasing impacts on societal safety and economy. How to quantify the impact of SLR and compound effects among various flood causes on compound flood have become important challenges. We propose a modeling framework which integrates atmospheric, storm tide and urban flood (IASTUF) models to characterize the various physical processes related to compound flood. Future SLR projections under various shared socioeconomic and respective concentration pathway emission scenarios are considered. Hengqin Island (Zhuhai City, China) frequently experiences typhoon conditions combined with rainstorm and storm surge events. Its population has increased more than sixfold during the past decade, stimulating urgent demands for assessments of the potential risks associated with future compound floods in the context of potential SLR. A compound flood event in northern Hengqin Island, caused by the super typhoon Mangkhut in 2018, is selected as a case study to verify the proposed modeling framework. Results show that the IASTUF modeling framework can capture well the combined processes of typhoon, rainstorm, storm tide and inland flooding and demonstrates good performance in quantifying compound flood magnitudes. Compared to the current scenario, the node flooding volume (from the drainage system) and the maximum inundation area (with inundation depths >1 m) in 2050 are projected to increase by 20-26 % and 41-85 %, respectively, and these increases rise to 46-84 % and 23-71 times by 2100. The inundation volumes and water depths due to compound events are larger than the sum of those caused by the corresponding single-cause events, indicating that concurrent rainstorm and storm surge induce positive compound effects on flood magnitude. These findings can provide guidance for the management and mitigation of future compound flood hazards driven by super typhoon events.

Climate and landuse change enhance spatio-temporal variability of Dongjiang river flow and ammonia nitrogen

The adverse impacts of climate and landuse change are threatening the availability of water quantity and its quality, yet there are limited understandings in the response of water availability to changing environment at different spatio-temporal scales. Aimed at quantifying the individual and superimposed effects of climate and landuse change on streamflow and ammonia nitrogen (NH₃-N) load in the Dongjiang River Basin (DRB), we dynamically simulated the historical (1981-2010) and future (2030-2070) variation of runoff depth and NH₃-N load coupling multiple regional climate model and landuse data. The increase in runoff depth (avg. +233.9 mm) due to climate change was about 33 times greater than that caused by landuse change (avg. -7.2 mm). Especially in the downstream of DRB (Hong Kong, Shenzhen and Dongguan cities, etc.), the maximum rise of runoff depth under climate change was near twice compared with baseline period, indicating the dominant control of climate change on runoff. Also there existed higher coefficient of variation (C_v) value of runoff in the dry season of downstream DRB, contributing potential great fluctuation in runoff. Besides, the variation of NH₃-N load was jointly influenced by climate and landuse change, revealing an offset or amplification effect. Moreover, the variability of NH₃-N load (C_v value as the metric) increased from 2030, reached a maximum in 2050, following decreased to 2070. The spatial distribution of NH₃-N load, in general, presented a downward trend and concentrated near the water body, while the monthly average NH₃-N load showed distinct peaks in spring and late summer temporally. Overall, the results highlight the significance of investigating the water availability under changing environment and more adaptive strategies should be proposed for better basin water management.

[Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index]

Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

A novel spatial optimization approach for the cost-effectiveness improvement of LID practices based on SWMM-FTC

Due to the increasingly frequent occurrence of urban waterlogging, the spatial optimization of low impact development (LID) practices has been commonly used to detain and reduce storm water runoff in the most cost-effective way. In this study, the flow transmission chain (FTC) was proposed to replace the routing portion of the Storm Water Management Model (SWMM) and was combined with the runoff component of the SWMM to simulate LID practices (SWMM-FTC). In the SWMM-FTC, the third Evolution Step of Generalized Differential Evolution (GDE3) was employed to optimize the LID layout design. The results showed that the relative error between the modified SWMM-FTC and the calibrated SWMM was less than 0.25% under various LID scenarios, and the computational efficiency of the SWMM-FTC was improved by 19.3 times. Moreover, the GDE3 outperformed the commonly used non-dominated sorting genetic algorithm (NSGA-II), the strength Pareto evolutionary algorithm (SPEA2), and the multi-objective shuffled frog leaping algorithm (MOSFLA) due to its ability to find the most cost-effective solution. The LID layout obtained from the SWMM-FTC with the GDE3 saved $210-1067 to achieve a 1% reduction in storm water runoff. This result demonstrates that the SWMM-FTC with the GDE3 can achieve higher environmental benefits than comparable models, providing better guidance for managers and stakeholders.

Effects of different cropping systems on ammonia nitrogen load in a typical agricultural watershed of South China

The excessive application of agricultural irrigation water and chemical fertilizer has increased crop yields to help meet the demand for food, but it has also led to major water environment problem, i.e. non-point source (NPS) pollution, which needs to be addressed to achieve sustainable development targets. Although numerous studies have focused on the control and reduction of agricultural NPS pollution from the perspective of irrigation and fertilizer, the effects of different cropping systems on NPS pollution (ammonia nitrogen (NH₃-N)) in the Dongjiang River Basin (DRB) were seldom assessed. Specifically, variation in the NH₃-N load was simulated and analyzed at the annual and semi-annual scales under ten different cropping systems using the Soil and Water Assessment Tool (SWAT) model, which was calibrated and validated with satisfactory statistical index values in the DRB. The results indicated that the NH₃-N load decreased, distinctly increased, slightly decreased when sweet potato, peanut, and rice were planted, respectively. Compared with mono-cropping, crop rotation could reduce the NH₃-N load, and the planting sequence of crops could affect the NH₃-N load to a certain extent. Planting peanuts in spring would dramatically increase NH₃-N load. To evaluate NH₃-N pollution, a critical threshold of NH₃-N emission (5.1 kg·ha^-1·year^-1) was proposed. Meeting the NH₃-N emission threshold cannot be achieved by altering the cropping system alone; additional measures are needed to reduce agricultural NPS pollution. This study facilitates the development of cropping systems and provides relevant information to aid the sustainable development of agriculture in the DRB.

Retrospective analysis of molecular biology mechanism of ABO blood group typing discrepancy among blood donors in Jinan blood station

BACKGROUND

To accurately identify ABO blood typing in pre-transfusion testing is very important to ensure blood transfusion safely, which is a major responsibility of blood station.

METHODS

Eighty-one blood donors samples with ABO blood group typing discrepancy was collected among 61952 donor samples in our blood station from January 2019 to July 2020. Blood group serological method was used to detect ABO blood group. DNA Sequencing was used to determine the genotype. The antibody screening test detects antibodies other than ABO.

RESULTS

In total, 61,952 donor samples were analysed for ABO typing discrepancies. The incidence among blood donors was 0.13% (81/61952). The most common reason of ABO typing discrepancies was due to specific antibody or non-specific agglutination (54.32%, 44/81), mainly anti-M antibody, cold autoantibody, anti-D antibody, anti-N antibody and anti-Lea antibody. The major cause of forward typing discrepancies among blood donors was ABO subgroups (25.93%, 21/81), including 10 cases of A subtype (1 case of A2, 2 cases of A3, 2 cases of Ax, 3 cases of AxB, 1 case of Ael, 1 case of Ahm), 6 cases of B subtype (2 cases of B3, 1 case of Bel, 3 cases of AB3), 2 cases of B subtype (A), 1 case of cisAB, and 2 cases of acquired B. The serum antibody was weakened in 16 cases (19.75%).

CONCLUSIONS

The blood types should be correctly identified by combining serology with gene sequencing to ensure the safety of clinical blood transfusion, when the forward and reverse typing discrepancies among the blood donors.

Anaemia among intensive care unit survivors and association with days alive and at home: an observational study

Anaemia is highly prevalent at the time of intensive care unit discharge and is persistent for a high proportion of intensive care unit survivors. Whether anaemia is a driver of impaired recovery after critical illness is uncertain. The aim of this study was to test the hypothesis that, in adult intensive care survivors, anaemia at the time of intensive care unit discharge independently predicts decreased days at home-90. This retrospective cohort study was conducted in a tertiary intensive care unit in Perth, Western Australia. All patients aged ≥ 16 years, discharged alive from their index intensive care unit admission and without documented treatment limitations were included. Median (IQR [range]) age of the 6358 participants was 61 (46-72 [16-95]) years and included 3385 (53.2%) unplanned admissions. Intensive care unit discharge with a haemoglobin concentration < 100 g.l^-1 occurred in 2886 (45.4%) patients, a threshold that identified a cohort with significantly lower days at home-90 (median (IQR [range]) 80 (64-85 [0-90]) days vs. 85 (77-88 [0-90]) days (median difference 5 days, 95%CI 4.4-5.5, p < 0.0001). The association followed a severity-response relationship with more severe anaemia predicting lower days at home-90. When accounting for prespecified covariates including admission haemoglobin concentration and red blood cell transfusion, anaemia at intensive care unit discharge remained a significant predictor of decreased days at home-90, relative risk 0.96 (0.93-0.98), p < 0.002. These findings support the need for interventional trials investigating whether this risk is modifiable.

Carbon dioxide-dependent signal transduction in mammalian systems

Carbon dioxide (CO2) is a fundamental physiological gas known to profoundly influence the behaviour and health of millions of species within the plant and animal kingdoms in particular. A recent Royal Society meeting on the topic of 'Carbon dioxide detection in biological systems' was extremely revealing in terms of the multitude of roles that different levels of CO2 play in influencing plants and animals alike. While outstanding research has been performed by leading researchers in the area of plant biology, neuronal sensing, cell signalling, gas transport, inflammation, lung function and clinical medicine, there is still much to be learned about CO2-dependent sensing and signalling. Notably, while several key signal transduction pathways and nodes of activity have been identified in plants and animals respectively, the precise wiring and sensitivity of these pathways to CO2 remains to be fully elucidated. In this article, we will give an overview of the literature relating to CO2-dependent signal transduction in mammalian systems. We will highlight the main signal transduction hubs through which CO2-dependent signalling is elicited with a view to better understanding the complex physiological response to CO2 in mammalian systems. The main topics of discussion in this article relate to how changes in CO2 influence cellular function through modulation of signal transduction networks influenced by pH, mitochondrial function, adenylate cyclase, calcium, transcriptional regulators, the adenosine monophosphate-activated protein kinase pathway and direct CO2-dependent protein modifications. While each of these topics will be discussed independently, there is evidence of significant cross-talk between these signal transduction pathways as they respond to changes in CO2. In considering these core hubs of CO2-dependent signal transduction, we hope to delineate common elements and identify areas in which future research could be best directed.

Response of non-point source pollution to landscape pattern: case study in mountain-rural region, China

Landscape patterns have a substantial effect on non-point source (NPS) pollution in watersheds. Facilitating sustainable development of mountain-rural areas is a major priority for China. Knowledge of the impacts of various landscapes on water quality in these areas is critical to meeting environmental goals. This study applied the Soil and Water Assessment Tool (SWAT) to create a hydrologic and water quality model of the study watershed; then, the relationship between water quality and landscape patterns was investigated using multiple linear regression and redundancy analysis. The results show that the western sub-basins had higher nitrogen pollution loads, and the total nitrogen concentration reached a maximum value of 3.91 mg/L; the eastern sub-basins had a higher pollution load of phosphorous featured by maximum total phosphorous concentration of 2.15 mg/L. The water quality of the entire watershed in all scenarios tended to deteriorate over time. Landscape metrics accounted for 81.7% of the total variation in pollutant indicators. The percentage of forest landscape was negatively correlated with NPS pollution, while other types of landscape showed a positive correlation. The patch density, landscape shape index, and largest patch index of urban and agricultural lands were negatively correlated with pollutant concentrations. Upland landscapes contributed more pollutants than paddy fields. Some measures, e.g., returning grassland and farmland to forest in steep regions and replacing upland crops with paddy fields, were recommended for mitigating NPS pollution in the study watershed.

Applicability of two satellite-based precipitation products for assessing rainfall erosivity in China

Soil erosion has become one of the most serious environmental problems worldwide, and rainfall is considered a crucial factor in water erosion. Rainfall erosivity is defined as the ability of precipitation to trigger soil erosion. The accurate assessment of rainfall erosivity is essential before taking appropriate measures to stop or slow down water erosion. In this study, we calculated the rainfall erosivity in China using the Xie model and two satellite-based precipitation products (SPPs). Gauge-based data from 2417 stations in China were used for a comparison of the results. We also proposed a procedure to assess the performance of the two SPPs using four statistical metrics and provided recommendations for different sub-regions at different time scales. The results showed that the annual rainfall erosivity based on the IMERG-F and TMPA 3B42-V7 products and the in situ gauge stations were 2014, 1954, and 2138 MJ·mm/(hm²·h·yr), respectively. The spatial correlation between IMERG-F and situ gauge stations is 0.944 and that between the TMPA 3B42-V7 product and situ gauge stations is 0.909. The variation trends of the two were highly similar to those of the gauge-based rainfall erosivity at all time scales. The TMPA 3B42-V7 product is recommended for estimating rainfall erosivity in Haihe River Basin and Huaihe River Basin at monthly scale, in Haihe River Basin and China at seasonal scale, in the Haihe River Basin, Huaihe River Basin, Yellow River Basin at annual scale; while the IMERG-F is recommended for the remaining regions except Continental Basins at the three time scales. Generally, the IMERG-F has broader applicability than the TMPA 3B42-V7 product for estimating rainfall erosivity in China. The results of this study provide a reference for selecting suitable SPPs for rainfall erosivity estimates.

Identification of proteins associated with development of metastasis from cutaneous squamous cell carcinomas (cSCCs) via proteomic analysis of primary cSCCs

BACKGROUND

Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers capable of metastasizing. Proteomic analysis of cSCCs can provide insight into the biological processes responsible for metastasis, as well as future therapeutic targets and prognostic biomarkers.

OBJECTIVES

To identify proteins associated with development of metastasis in cSCC.

METHODS

A proteomic-based approach was employed on 105 completely excised, primary cSCCs, comprising 52 that had metastasized (P-M) and 53 that had not metastasized at 5 years post-surgery (P-NM). Formalin-fixed, paraffin-embedded cSCCs were microdissected and subjected to proteomic profiling after one-dimensional (1D), and separately two-dimensional (2D), liquid chromatography fractionation.

RESULTS

A discovery set of 24 P-Ms and 24 P-NMs showed 144 significantly differentially expressed proteins, including 33 proteins identified via both 1D and 2D separation, between P-Ms and P-NMs. Several differentially expressed proteins were also associated with survival in SCCs of other organs. The findings were verified by multiple reaction monitoring on six peptides from two proteins, annexin A5 (ANXA5) and dolichyl-diphosphooligosaccharide-protein glycosyltransferase noncatalytic subunit (DDOST), in the discovery group and validated on a separate cohort (n = 57). Increased expression of ANXA5 and DDOST was associated with reduced time to metastasis in cSCC and decreased survival in cervical and oropharyngeal cancer. A prediction model using ANXA5 and DDOST had an area under the curve of 0·93 (confidence interval 0·83-1·00), an accuracy of 91·2% and higher sensitivity and specificity than cSCC staging systems currently in clinical use.

CONCLUSIONS

This study highlights that increased expression of two proteins, ANXA5 and DDOST, is significantly associated with poorer clinical outcomes in cSCC.

The Global Leadership Mentoring Community: building capacity across seven global regions

AIM

The purpose of this paper is to report on the evaluation of the online Global Leadership Mentoring Community, a programme designed to build relationships across seven global regions and promote leadership development for emerging nurse leaders.

BACKGROUND

There is a pressing need and opportunity for sustainable global leadership mentoring programmes. This programme of Sigma Theta Tau International (Sigma) brought mentors and mentees together from across the world to build leadership capacity, understand global leadership issues and build networks. Community coordinators purposively selected mentors from each of Sigma's seven Global Regions, and mentees were chosen through a process of snowball sampling. Mentors and mentees met monthly with quarterly group calls.

METHODS

The study followed a programme evaluation, outcomes-focused approach. All eleven pairs of mentors-mentees were invited to complete online surveys at the outset and end of programme capturing both quantitative and qualitative data. Quantitative data were analysed using descriptive statistics and for qualitative data, a thematic analysis.

FINDINGS

Quantitative data confirmed that all 22 participants gained from the experience. From qualitative analysis, themes emerged illustrating the scope of achievements: 1. facilitation of successful outcomes for both mentors and mentees, 2. challenges of global mentoring and 3. strategies for successful global mentoring.

DISCUSSION/CONCLUSION

Participants reported that creating global leadership is a longitudinal process that needs sustained attention to effect change. This evaluation identified many strengths of the programme and recommended its continuation to help further development of global leaders, particularly through focusing more purposefully on policy issues.

IMPLICATIONS FOR NURSING POLICY

Empowerment of nurses globally through a Global Leadership Mentoring Community can improve leadership at all levels, thus emboldening their voices to influence nursing and health policy and ultimately improve patient care.

Psychological, emotional and social impairments are associated with adherence and healthcare spending in type 2 diabetic patients: an observational study

OBJECTIVE

The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients.

PATIENTS AND METHODS

Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending.

RESULTS

Mathematical linear regressions models were performed showing the predictive effects of: anxiety and social support scores (RSAS) on adherence levels (respectively p =. 019; p =. 016); adherence levels on anxiolytic use (p =.04); aggressiveness scores (RSAS) on the number of general check-ups (p =.031); TAS-20 and physician-patient communication (IPC) on the number of hospitalization days (respectively p=.001; p=.008); physician patient decision making (IPC) scores on physical activity (IPAQ) levels (p=.025); physical activity (IPAQ) on the number of medical examinations (p=.039).

CONCLUSIONS

An association among psychosocial impairment, adherence and healthcare spending was found. Future studies should investigate the effect of a brief psychological intervention in increasing adherence levels and reducing the healthcare spending in this clinical population.

Flood Risk Assessment and Regionalization from Past and Future Perspectives at Basin Scale

Flooding is a major natural disaster that has brought tremendous losses to mankind throughout the ages. Even so, floods can be controlled by appropriate measures to minimize loss and damage. Flood risk assessment is an essential analytic step in preventing floods and reducing losses. Identifying previous flood risk and predicting future features are conducive to understanding the changing patterns and laws of flood risk. Taking the Dongjiang River basin as a study case, we assessed and regionalized flood risk in 1990, 2000, and 2010 from the past perspective and explored dynamic expansion during 1990-2010. Then, we projected land-use type, population, and gross domestic product in 2030 and 2050 and finally assessed and regionalized the risk from a future perspective. Results show that areas with very high risk accounted for 14.98-18.08% during 1990-2010; approximately 13.90% areas of the basin transformed from lower-level risk to higher-level risk whereas 9.07% fell from a higher level to a lower level during the period. For the future scenario, areas with very high and high risk in 2030 and 2050 are expected to account for 21.55% and 24.84%, respectively. Generally, our study can better identify changes in flood risk at a spatial scale and reveal the dynamic evolution rule, which provides a synthetical means of flood prevention and reduction, flood insurance, urban planning, and water resource management in the future under global climate change, especially for developing or high-speed urbanization regions.

AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

Background:

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.

Objectives:

To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.

Methods:

Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.

Results:

17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).

Conclusion:

PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.

References:

[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737

[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253

[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13

Disclosure of Interests: :

Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

0024 PTSD with Concurrent Excessive Daytime Sleepiness Alters Gene Expression in Military Personnel and Veterans; An RNA-Sequencing Study

Introduction

Up to 91% of military personnel and veterans with posttraumatic stress disorder (PTSD) report co-occurring sleep disturbances, including. insomnia and excessive daytime sleepiness (EDS). Sleep disturbances have been shown not only to increase the risk of developing PTSD, but to exacerbate and maintain PTSD symptomology. The aim of this study was to examine gene expression in active duty military personnel and veterans with PTSD, with and without EDS. Participants were categorized into three groups; 1) PTSD with EDS (PTSDwEDS; n=21), 2) PTSD without EDS (PTSDnoEDS; n=25), or 3) Controls (no PTSD and no EDS; n=57).

Methods

Participants were 79% male, mean age of 37.6years (SD=11.2years). PTSD symptoms were measured using the PTSD checklist for civilians (PCL-C); participants were classified as PTSD-present using DSM-IV-TR criteria of “moderate-to-severe”. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS), high sleepiness was indicated by an ESS score &gt;13. We performed RNA-seq with Illumina’s HiSeq 2500 in paired-end. We conducted quality control using FastQC and aligned to GRCh38 reference genome using STAR (v2.5.3a). Differentially expressed genes identified using DESeq2 (v1.20.0) with False Discovery Rate of 0.10. Finally, Ingenuity Pathway Analysis (IPA) was conducted to identify dysregulated gene networks.

Results

Between the Controls and PTSDnoEDS groups, two genes were significantly dysregulated. In controls and PTSDwEDS groups, 251 genes were dysregulated. The IPA networks showed that genes associated with inflammation were significantly dysregulated. Finally, between PTSDwEDS and PTSDnoEDS there were 1,873 significantly dysregulated genes. The IPA networks identified dysregulation of genes related to sleep, fatigue, circadian, and mitochondrial function.

Conclusion

Taken together this data indicates that EDS that is co-morbidly experienced with PTSD is associated with significant gene dysregulation, above and beyond that observed in participants with PTSD without significant EDS and controls. Treating EDS in military personnel and veterans with PTSD is important.

Support

This work was supported by the Center for Neuroscience and Regenerative Medicine (CNRM)

1118 Examining the Role of Serum and Exosomal Biomarkers in Symptoms of Fatigue and Daytime Sleepiness Following Traumatic Brain Injury

Introduction

Fatigue and daytime sleepiness are two of the most common chronic symptoms reported after traumatic brain injury (TBI). However, there is limited understanding of the pathophysiological mechanisms following TBI that result in these symptoms. Previous research has observed elevations in peripheral blood levels of proteins in TBI patients versus controls, including neurofilament light chain (NFL)—predominantly expressed in long myelinated subcortical axons—and glial fibrillary acidic protein (GFAP)—predominantly expressed in reactive astrocytes responding to central nervous system injuries. This study examines the relationship between serum and exosomal NFL and GFAP, and symptoms of fatigue and daytime sleepiness in TBI patients 1-year after injury.

Methods

Sixty-seven patients with TBIs ranging from mild to severe were included in this study. Blood samples were collected from all participants 1-year post TBI, with concentrations of GFAP and NFL measured in serum and exosomes using Single Molecule Array technology (Simoa), an ultrasensitive assay. Participants reported fatigue using the Fatigue Severity Scale (FSS), and daytime sleepiness using the Epworth Sleepiness Scale (ESS).

Results

A linear regression model of fatigue symptoms and exosomal NFL controlling for age revealed that fatigue was negatively associated with exosomal NFL concentrations (β = -.317, p = .041, ηp2 = -.343) and accounted for 20.2% of the change in NFL. Serum NFL concentrations were not associated with fatigue, nor were GFAP serum or exosomes. No significant associations were found between NFL, GFAP, and daytime sleepiness.

Conclusion

Our findings suggest that exosomal NFL may be related to mechanisms underlying TBI-related fatigue and the potential of NFL as a biomarker of fatigue. To our knowledge, this study is the first to examine the relationship between post-TBI NFL levels and fatigue symptoms. Further investigation into serum and exosome biomarkers of TBI-related fatigue and daytime sleepiness is warranted.

Support

National Institutes of Health and Center for Neuroscience and Regenerative Medicine

Severe drought events inducing large decrease of net primary productivity in mainland China during 1982-2015

The analysis of the impact of drought events on terrestrial net primary productivity (NPP) is significant to understand the effects of droughts on regional/global carbon cycling. During the past three decades, terrestrial ecosystems in mainland China have been frequently impacted by drought events. However, quantitative analyses of the variation of NPP induced by droughts are still not enough. Therefore, this study explored the response of NPP to drought events from 1982 to 2015 based on the standardized evapotranspiration deficit index (SEDI) and an NPP dataset obtained from the Carnegie-Ames-Stanford Approach model. We first identified drought events and analyzed the characteristics of drought events using a three-dimensional clustering algorithm. Subsequently, we determined the NPP variations in the drought-affected areas during the droughts and explored the correlation between the NPP variation and the drought characteristics. The results showed that 152 persistent drought events lasting at least 3 months were identified. Most events had durations between 3 and 5 months, and 19 events lasted >9 months. A negative NPP was detected in >60% of the drought-affected areas during long-term (>6 months) and severe (>4 × 10⁶ km² month) drought events and the total NPP showed a clear decrease during these events. In general, strong drought events reduced the total NPP by >30 TgC in the Northern Region, South Region, Southwest Region, and Northeast Region. The substantial decrease was mainly caused by the NPP anomaly from April to September. The NPP responses to drought events exhibited differences due to different drought characteristics. Although a high proportion of the drought-affected areas experienced a decrease in NPP during most short-term (<5 months) and less severe droughts (<2 × 10⁶ km² month), the total NPP did not exhibit a large change during these events.

Patient decision-making in severe inflammatory bowel disease: the need for improved communication of treatment options and preferences

AIM

Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease.

METHODS

We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making.

RESULTS

Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions.

CONCLUSION

Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.

Socio-emotional ability, temperament and coping strategies associated with different use of Internet in Internet addiction

OBJECTIVE

The aim of the present study was to compare socio-emotional patterns, temperamental traits, and coping strategies, between a group of Internet addiction (IA) patients and a control group.

PATIENTS AND METHODS

Twenty-five IA patients and twenty-six healthy matched subjects were tested on IA, temperament, coping strategies, alexithymia and attachment dimensions. Participants reported their prevalent Internet use (online pornography, social networks, online games).

RESULTS

The IA patients using Internet for gaming online showed a greater attitude to novelty seeking and a lower tendency to use socio-emotional support and self-distraction compared to patients using Internet for social networking. Moreover, they showed a lower level of acceptance than patients using Internet for pornography. In the control group, the participants using Internet for online gaming showed higher levels of IA, emotional impairments and social alienation compared to social-networks and pornography users.

CONCLUSIONS

Findings showed a higher psychological impairment in gaming online users compared to social networking and online pornography users.

Role of surgical setting and patients-related factors in predicting the occurrence of postoperative pulmonary complications after abdominal surgery

OBJECTIVE

The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery.

PATIENTS AND METHODS

After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation.

RESULTS

PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showed that urgent setting (p=0.000), Ariscat (Assess Respiratory Risk in Surgical Patients in Catalonia) score (p=0.004), and age (p=0.01) were predictors of PPCs. A cut-off of 23 for Ariscat score was also identified as determining factor for PPCs occurrence with 94% sensitivity and 29% specificity.

CONCLUSIONS

Patients undergoing abdominal surgery in an urgent setting were exposed to a higher risk of PPCs compared to patients scheduled for elective procedures. Ariscat score fitted with PPCs prevalence and older patients were exposed to a higher risk of PPCs. Prospective studies are needed to confirm these results.

P5516Short-term and long-term mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays

Background

As in other countries, manpower shortage in weekends and holidays is a common problem in either private hospitals or public hospitals in Taiwan. Whether the manpower shortage in weekends and holidays is associated with poor quality of medical care is a noteworthy subject and several investigations from different countries have been published already.

Purpose

This study examined the difference of short-term and long-term mortality between acute myocardial infraction patients admitted to hospitals on weekends and weekdays in Taiwan.

Methods

We conducted a retrospective, nationwide cohort study based on the National Health Insurance claims database in Taiwan. Adult patients aged 20 years or older who were admitted with a diagnosis of acute myocardial infarction between Jan. 1 2006 and Dec. 31 2014 were identified. Only the first attack of acute myocardial infarction was retained for analysis. The multivariate logistic regression model was applied with adjustment of baseline characteristics at both patient level and hospital level. The outcome variables included in-hospital mortality and one-year cumulative mortality after the index hospitalization.

Results

We identified 53861 patients with acute myocardial infarction as the weekend group, while 130908 patients as the weekday group. The mean age was 68 years old and 68% of the subjects were male in both groups. ST-elevation myocardial infarction constituted 23% of the patients and up to 46% of the subjects underwent percutaneous coronary intervention during the index hospitalization in both groups. Among the weekend group, the in-hospital mortality was 15.8% while the in-hospital mortality was 16.2% in the weekday group (standardized difference = 0.01). The one-year cumulative mortality was 30.2% and 30.9% in the weekend group and the weekday group, respectively (standardized difference = 0.02). The adjusted odds ratio (aOR) concerning in-hospital mortality of the weekend group compared with the weekday group was 0.98 (95% confidence interval [CI]: 0.95–1.01, p=0.11). Also we found no difference in one-year cumulative mortality between the two study groups (aOR = 0.98, 95% CI: 0.96–1.01, p=0.15).

Conclusions

As for acute myocardial infraction patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or one-year cumulative mortality.

Acknowledgement/Funding

Ministry of Science and Technology, the Executive Yuan, Taiwan (MOST 106-2410-H-002-218-, and MOST 107-2410-H-002-237-)

Modulation of the Wnt pathway through inhibition of CLK2 and DYRK1A by lorecivivint as a novel, potentially disease-modifying approach for knee osteoarthritis treatment

OBJECTIVES

Wnt pathway upregulation contributes to knee osteoarthritis (OA) through osteoblast differentiation, increased catabolic enzymes, and inflammation. The small-molecule Wnt pathway inhibitor, lorecivivint (SM04690), which previously demonstrated chondrogenesis and cartilage protection in an animal OA model, was evaluated to elucidate its mechanism of action.

DESIGN

Biochemical assays measured kinase activity. Western blots measured protein phosphorylation in human mesenchymal stem cells (hMSCs), chondrocytes, and synovial fibroblasts. siRNA knockdown effects in hMSCs and BEAS-2B cells on Wnt pathway, chondrogenic genes, and LPS-induced inflammatory cytokines was measured by qPCR. In vivo anti-inflammation, pain, and function were evaluated following single intra-articular (IA) lorecivivint or vehicle injection in the monosodium iodoacetate (MIA)-induced rat OA model.

RESULTS

Lorecivivint inhibited intranuclear kinases CDC-like kinase 2 (CLK2) and dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). Lorecivivint inhibited CLK2-mediated phosphorylation of serine/arginine-rich (SR) splicing factors and DYRK1A-mediated phosphorylation of SIRT1 and FOXO1. siRNA knockdowns identified a role for CLK2 and DYRK1A in Wnt pathway modulation without affecting β-catenin with CLK2 inhibition inducing early chondrogenesis and DYRK1A inhibition enhancing mature chondrocyte function. NF-κB and STAT3 inhibition by lorecivivint reduced inflammation. DYRK1A knockdown was sufficient for anti-inflammatory effects, while combined DYRK1A/CLK2 knockdown enhanced this effect. In the MIA model, lorecivivint inhibited production of inflammatory cytokines and cartilage degradative enzymes, resulting in increased joint cartilage, decreased pain, and improved weight-bearing function.

CONCLUSIONS

Lorecivivint inhibition of CLK2 and DYRK1A suggested a novel mechanism for Wnt pathway inhibition, enhancing chondrogenesis, chondrocyte function, and anti-inflammation. Lorecivivint shows potential to modify structure and improve symptoms of knee OA.

Abstract OT3-05-02: ALEXANDRA/IMpassion030: A phase III study of standard adjuvant chemotherapy with or without atezolizumab in early triple negative breast cancer

Background: Triple negative breast cancer (TNBC) is a subtype with a high risk of relapse in the early disease setting. Because TNBC does not currently have specific targeted agents approved for use in the early setting it is treated primarily with chemotherapy. A growing body of evidence indicates that TNBC is more immunogenic than other subtypes of breast cancer and promising clinical activity has been reported with atezolizumab (an anti–PD-L1 antibody) in Phase 1/1b metastatic TNBC trials. Furthermore, the anti-tumor activity of PD-1/PD-L1 targeting drugs is hypothesized to be enhanced when co-administered with chemotherapy. ALEXANDRA/IMpassion030 will evaluate the efficacy and safety of atezolizumab in combination with standard adjuvant chemotherapy in early TNBC.

Methods: ALEXANDRA/IMpassion030 is a global, prospective, randomised, open-label Phase 3 trial investigating the efficacy, safety and pharmacokinetic (PK) profile of adjuvant atezolizumab plus standard chemotherapy versus chemotherapy alone in early TNBC. In total, 2300 patients diagnosed with non-metastatic operable stage II or III TNBC confirmed by central pathology review will be randomised. TumorPD-L1evaluationwill be performed centrally. Patients will be stratified by type of surgery, nodal status, and PD-L1 status. The adjuvant treatment will consist of weekly paclitaxel 80 mg/m2 for 12 weeks followed by dose dense anthracycline (epirubicin 90 mg/m2 or doxorubicin 60 mg/m2) and cyclophosphamide 600 mg/m2 for 4 doses every 2 weeks or the same chemotherapy regimen (T-EC/AC) given concomitantly with atezolizumab 840 mg every 2 weeks followed by maintenance atezolizumab 1200 mg every 3 weeks until completion of 1 year of atezolizumab. Primary end-point is invasive disease-free survival (iDFS) and secondary end-points include iDFS by PD-L1 and lymph node status, overall survival, safety, patient functioning and health related quality of life (HRQoL). Tumour tissue and blood samples will be collected for biomarker research. The first site was activated in May 4th, and approximately 430 sites are expected to be open globally in 30 countries. This trial is sponsored by Roche and conducted in partnership with the Breast International Group, Frontier Science and Technology Research Foundation, Institute Jules Bordet and Alliance Foundation Trials. Clinicaltrials.gov NCT03498716.

Citation Format: Ignatiadis M, McArthur H, Bailey A, Martinez J-L, De Azambuja E, Metzger O, Lai C, Ponde N, Goulioti T, Daly F, Bouhlel A, Balta V, Van Dooren V, Viale G, Maetens M, Dufrane C, Nguyen Duc A, Winer E, Gelber R, Piccart M. ALEXANDRA/IMpassion030: A phase III study of standard adjuvant chemotherapy with or without atezolizumab in early triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-02.

Monitoring hydrological drought using long-term satellite-based precipitation data

Long-term (over 30a) satellite-based quantitative rainfall estimate (SRE) products provide an ideal data source for hydrological drought monitoring. This study mainly explores the suitability of the two long-term SREs, the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks-Climate Data Record (PERSIANN-CDR) and the Climate Hazards Group (CHG) Infrared Precipitation with Stations (CHIRPS), for hydrological drought monitoring. A hydrological drought index called the standardized streamflow index (SSI) was used as an example and the Grid-based Xinanjiang (GXAJ) hydrological model was used for streamflow generation of the SREs. A middle size basin in the humid region of south China was selected as case study. The obtained results show that both SREs present acceptable performances for hydrological modeling, and CHIRPS outperformed PERSIANN-CDR. SSIs calculated by the SRE simulations generally fit well with the trend of observation-based on SSI but apparent deviations in drought intensity were also found. In contrast to hydrological modeling, performance of the SRE-based SSI showed almost no change after model recalibration. Both SREs generally present acceptable classification accuracy but tended to underestimate the levels of drought types. Both SREs accurately captured the beginning, end, and duration of this drought event; however, several deviations were found in severity and intensity estimation of the drought event. In general, both SREs are suitable for hydrological drought monitoring. Although the CHIRPS generally presented better performance, the PERSIANN-CDR is still adequate for hydrological drought monitoring.

Life threatening pembrolizumabinduced myositis in a patient treated for advanced adenocarcinoma of the lung

The advent of immunotherapy in oncology has led to the emergence of a new spectrum of adverse effects. A number of these have the potential to contribute to life-threatening outcomes; and therefore require prompt identification and aggressive treatment to optimise management. In this report, we describe a case of pembrolizumab-induced CTCAE (common toxicity criteria for adverse events) grade 4 myositis in a non-small cell lung cancer patient.

Response of net primary production to land use and land cover change in mainland China since the late 1980s

Land use and land cover patterns in mainland China have substantially changed in the recent decades under the economic reform policies of the government. The terrestrial carbon cycle, particularly the net primary productivity (NPP), has been substantially changed on both local and national scales. With the growing concern over the effects of the terrestrial carbon cycle on global climate changes, the impacts of land use and cover change (LUCC) on NPP need to be understood. In this study, variations in NPP caused by LUCC (e.g., urbanization and conversion of other land use to forest and grassland) in mainland China from the late 1980s to 2015 were evaluated based on land cover datasets and NPPs simulated from the Carnegie-Ames-Stanford Approach model. The results indicate that the national total losses in NPP attributed to urbanization reached 1.695 TgC between the late 1980s and 2015. A large proportion (63.02%) of the total losses was due to the transformation from cropland to urban land. Urban expansion decreased the monthly and total NPPs over southern China, which includes the South China Region, Southwest China Region, and the middle and lower regions of the Yangtze River. However, the total NPP increased in the majority of urbanized areas in Northern China, including the Huang-Huai-Hai Region, Inner Mongolia Region (MGR), Gan-Xin Region (GXR), and Northeast China Region; monthly NPP in GXR and MGR increased throughout the year. By contrast, the conversion to grassland or forestland increased the monthly and total NPPs of Northern China, suggesting that returning to forestland and grassland could increase the carbon sequestration capacity of terrestrial ecosystems in mainland China. Among the sub-regions, the Loess Plateau Region contributed the largest increase in NPP, which was prompted by the conversion to grassland and forestland.

Integrating the social, hydrological and ecological dimensions of freshwater health: The Freshwater Health Index

Degradation of freshwater ecosystems and the services they provide is a primary cause of increasing water insecurity, raising the need for integrated solutions to freshwater management. While methods for characterizing the multi-faceted challenges of managing freshwater ecosystems abound, they tend to emphasize either social or ecological dimensions and fall short of being truly integrative. This paper suggests that management for sustainability of freshwater systems needs to consider the linkages between human water uses, freshwater ecosystems and governance. We present a conceptualization of freshwater resources as part of an integrated social-ecological system and propose a set of corresponding indicators to monitor freshwater ecosystem health and to highlight priorities for management. We demonstrate an application of this new framework -the Freshwater Health Index (FHI) - in the Dongjiang River Basin in southern China, where stakeholders are addressing multiple and conflicting freshwater demands. By combining empirical and modeled datasets with surveys to gauge stakeholders' preferences and elicit expert information about governance mechanisms, the FHI helps stakeholders understand the status of freshwater ecosystems in their basin, how ecosystems are being manipulated to enhance or decrease water-related services, and how well the existing water resource management regime is equipped to govern these dynamics over time. This framework helps to operationalize a truly integrated approach to water resource management by recognizing the interplay between governance, stakeholders, freshwater ecosystems and the services they provide.