[The predictive value of microvascular obstruction for adverse left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a prospective study]

Objectives: Microvascular obstruction (MVO) is a specific cardiac magnetic resonance (CMR) imaging feature in patients with acute myocardial infarction. The purpose of this study was to elucidate the predictive value of MVO in left ventricular adverse remodeling after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 167 patients with STEMI undergoing primary PCI in the Chinese PLA General Hospital from 2016 to 2020 were enrolled in this prospective cohort study, the average age of study patients was 57±10 years old, with 151 males (90.4%) and 16 females (9.6%). The patients were divided into the MVO group (n=81) and non-MVO group (n=86) according to the presence or absence of MVO on CMR imaging, respectively. The primary endpoint of the study was the occurrence of left ventricular adverse remodeling, which was defined as an increase in left ventricular end diastolic volume (LVEDV) by >20% at 6 months after primary PCI compared with the baseline. Patients who completed follow-up were diagnosed as left ventricular adverse remodeling or no left ventricular adverse remodeling according to CMR. The baseline data, perioperative data, and related data of end points were compared between the MVO group and non-MVO group. Finally, the predictive value of MVO in left ventricular adverse remodeling was calculated by receiver operating characteristic curve analysis. Results: In the baseline data, preoperative thrombolysis in myocardial infarction (TIMI) flow (χ2=13.74, P=0.003) and postoperative TIMI flow (χ2=14.87, P=0.001) were both obviously decreased in the MVO group. After 6 months of follow-up, the incidence of left ventricular adverse remodeling in the MVO group was significantly higher than that in the non-MVO group [37.0%(27/73) vs. 18.9%(14/74), χ2=5.96, P=0.015]. The left ventricular end systolic volume at 6 months post infarction in the MVO group was significantly larger than that in the non-MVO group [(94±32) vs. (68±20) ml, t=-5.98, P<0.001], as well as the LVEDV [(169±38) vs. (143±29) ml, t=-4.74, P<0.001]. Receiver operating characteristic curve showed that the area under the curve of MVO size for predicting left ventricular adverse remodeling was 0.637. Conclusion: The risk of left ventricular adverse remodeling is significantly increased in patients with MVO after primary PCI for acute STEMI.

[Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography]

Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm² vs.-0.33 (-0.83, 0.26)mm², P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm² vs.-0.26 (-0.64, 0.29)mm², P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm² vs. (-0.22±0.52)mm², P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm² vs.-0.01 (-0.45, 0.63) mm², P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.

Os LncRNAs Estão Envolvidos no Processo de Aterosclerose em Diversos Níveis

A aterosclerose é a causa mais comum de doença cardiovascular em todo o mundo, ela está associada a uma alta incidência de eventos clínicos. O acúmulo de evidências elucidou que os RNAs longos não codificantes (LncRNAs) são uma nova classe de transcritos com papéis críticos nos processos fisiopatológicos da aterosclerose. Nesta revisão, resumimos o progresso recente dos LncRNAs no desenvolvimento da aterosclerose. Descrevemos principalmente os diversos mecanismos regulatórios dos LncRNAs nos níveis transcricionais e pós-transcricionais. Este estudo pode fornecer informações úteis sobre os LncRNAs como alvos terapêuticos ou biomarcadores para o tratamento da aterosclerose.

POS1234 DMARD DISRUPTION, INCREASED DISEASE ACTIVITY, AND PROLONGED SYMPTOM DURATION AFTER ACUTE COVID-19 AMONG PATIENTS WITH RHEUMATIC DISEASE: A PROSPECTIVE STUDY

Background

Systemic autoimmune rheumatic disease (SARD) patients may be at risk for disease flare and prolonged symptom duration after COVID-19, perhaps related to DMARD disruption and immune activation.

Objectives

To describe DMARD disruption and identify differences in SARD activity among patients with and without prolonged COVID-19 symptom duration.

Methods

We identified all SARD patients with confirmed COVID-19 at the Mass General Brigham healthcare system in Boston, USA; prospective recruitment is ongoing. Surveys were used to collect demographics, clinical characteristics, DMARD disruption, COVID-19 course, and SARD disease activity before and after COVID-19. The survey included validated instruments measuring disease activity, pain, fatigue, functional status, and respiratory quality of life. Prolonged symptom duration was defined as COVID-19 symptoms lasting ≥28 days. We compared differences in patient-reported measures between those with and without prolonged symptoms.

Results

We analyzed survey responses from 174 COVID-19 survivors with SARDs (mean age 52±16 years, 81% female, 80% White). The most common SARDs were RA (40%) and SLE (14%). Fifty-one percent of the 127 respondents on any DMARD reported a disruption to their regimen at COVID-19 onset (Figure 1). Among individual DMARDs, 56-77% were reported to have any change, except for hydroxychloroquine (23%) and rituximab (46%). SARD flare after COVID-19 was reported by 41% of respondents (Table 1). Patient global assessment of SARD activity was worse after COVID-19 (mean 7.6±2.3 before vs. 6.6±2.9 after COVID-19, p<0.001). Prolonged symptom duration was reported by 45% of participants. Those with prolonged symptoms had a higher initial COVID-19 symptom count (median 7 vs. 4, p<0.001) and were more likely to be hospitalized for COVID-19 (28% vs. 17%, p=0.001). Respondents experiencing prolonged symptom duration had higher disease activity on RAPID3 (p=0.007) as well as more pain (p<0.001) and fatigue (p=0.03) compared to those without prolonged symptoms.

Table 1.

Acute COVID-19 course, SARD flare/activity, and patient-reported outcomes among COVID-19 survivors with SARDs.

All COVID-19 survivors with SARDs (n=174)Prolonged symptom duration ≥28 days (n=78)No prolonged symptom duration/(n=96)p-value (prolonged vs. not)Acute COVID-19 courseCOVID-19 symptom duration, days, median [IQR]14 [9, 29]46 [30, 65]11 [7, 14]<0.0001Initial symptom count, median [IQR]6 [3, 8]7 [6, 9]4 [2, 7]<0.001Hospitalized, n (%)38 (22)22 (28)16 (17)0.001SARD flare/activitySelf-reported SARD flare after COVID-19, n (%)71 (41)38 (49)33 (34)0.15Disease activity by RAPID3, median [IQR]9 [4, 14]11.2 [6, 16]7 [3, 13]0.0067RAPID3 categorical score, n (%)0.13Remission (0)11 (7)4 (5)7 (7)Near remission (0.3-1.0)23 (14)5 (7)18 (19)Low severity (1.3-2.0)26 (15)10 (14)16 (17)Moderate severity (2.3-4.0)55 (33)27 (36)28 (29)High severity (4.3-10.0)54 (32)28 (38)26 (27)Patient-reported outcomesPain by SF-MPQ, median [IQR]2 [1, 2]2 [1, 2]1 [0, 2]0.0008Fatigue by FSI, median [IQR]53 [27, 84]66 [31, 91.5]43 [26, 76]0.031mHAQ, median [IQR]0.125 [0, 0.38]0.25 [0, 0.75]0.125 [0, 0.38]0.11Respiratory quality of life by SGRQ, global [IQR]15 [4, 29]16 [4, 36]10 [4, 26]0.49

RAPID3, Routine Assessment of Patient Index Data 3; SF-MPQ, Short-form McGill Pain Questionnaire; FSI, Fatigue Symptom Inventory; mHAQ, modified Health Assessment Questionnaire; SGRQ, Saint George’s Respiratory Questionnaire.

Figure 1.

Frequency of baseline DMARD use and proportion with any disruption at COVID-19 onset.

Conclusion

DMARD disruption, SARD flare, and prolonged symptoms were common in this prospective study of COVID-19 survivors with SARDs. Those with prolonged COVID-19 symptom duration, defined as ≥28 days, had higher SARD activity, more pain, and more fatigue compared to those without prolonged symptoms. These findings suggest that post-acute sequelae of COVID-19 may have a large impact on underlying SARD activity and quality of life.

Disclosure of Interests

Michael Di Iorio: None declared, Claire Cook: None declared, Kathleen Vanni: None declared, Naomi Patel Consultant of: Receives consulting fees from FVC Health unrelated to this work., Kristin D’Silva: None declared, Xiaoqing Fu: None declared, Jiaqi Wang: None declared, Lauren Prisco: None declared, Emily Kowalski: None declared, Alessandra Zaccardelli: None declared, Lily Martin: None declared, Grace Qian: None declared, Tiffany Hsu: None declared, Zachary Wallace Consultant of: Receives consulting fees from Viela Bio, Zenas BioPharma, and MedPace unrelated to this work., Grant/research support from: Receives research support from Bristol-Myers Squibb and Principia/Sanofi., Jeffrey Sparks Consultant of: Receives consultant fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer unrelated to this work., Grant/research support from: Receives research support from Bristol Myers Squibb.

OP0251 IMPACT OF INTERSTITIAL LUNG DISEASE ON SEVERE COVID-19 OUTCOMES FOR PATIENTS WITH RHEUMATOID ARTHRITIS: A MULTICENTER STUDY

Background

RA has been associated with poor COVID-19 outcomes, but few studies have investigated outcomes in RA features such as interstitial lung disease.

Objectives

To assess COVID-19 outcomes in patients with RA overall, and those with and without ILD, compared to general population comparators.

Methods

A multicenter, retrospective cohort study was conducted at Mayo Clinic (19 hospitals and affiliated outpatient centers in 4 states) and Mass General Brigham (14 hospitals and affiliated outpatient centers in New England). Consecutive patients with RA meeting ACR/EULAR criteria and a positive COVID-19 test from March 1, 2020 through June 6, 2021 were matched 1:5 on age, sex, race, and COVID-19 test date with general population comparators without RA. RA features assessed included: RA-ILD per Bongartz criteria [1], duration, rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), bone erosions, and treatments. The primary outcome was a composite of hospitalization or death following COVID-19 diagnosis. We used multivariable Cox regression to investigate the association of RA, and features such as ILD, with COVID-19 outcomes compared to matched comparators.

Results

We analyzed 582 patients with RA and 2892 comparators without RA, all with COVID-19. Mean age was 62 years, 51% were female, and 79% were White. Mean RA duration was 11 years, 67% were seropositive (52% RF+ and 54% CCP+), 27% had bone erosions, 28% were on steroids, and 79% were on DMARDs. 50/582 (9%) patients with RA had ILD.

The COVID-19 hospitalization or death rate for RA patients was higher than comparators (3.0 per 1,000 days [95% CI 2.5-3.6] vs. 1.9 per 1,000 days [95% CI 1.7-2.1], respectively). Overall, RA patients had a 53% higher risk of hospitalization or death than comparators after adjustment (95% CI 1.20-1.94).

Among those with RA-ILD, the hospitalization or death rate was significantly higher than comparators (10.9 [95% CI 6.7-15.2] vs. 2.5 per 1,000 days [1.8-3.2], respectively). RA-ILD was associated with nearly 3-fold higher risk for hospitalization or death than comparators (multivariable HR 2.84 [95% CI 1.64-4.91], Table 1). There was a significant interaction between RA/comparator status and presence/absence of ILD for risk of severe COVID-19 (p<0.001, Figure 1). The elevated risk for severe COVID-19 was similar for RA subgroups defined by serostatus or bone erosions.

Table 1.

Frequencies, proportions, and hazard ratios for COVID-19 outcomes, comparing all RA patients, and subgroups with or without RA-ILD, to matched comparators.

COVID-19 OutcomesAll RA Patients (n=582)RA-ILD (n=50)RA Patients without ILD (n=532)Comparators (n=2,892)Hospitalization, n (%)121 (21)24 (48)97 (18)402 (14)Unadjusted HR (95% CI)1.58 (1.27, 1.96)2.65 (1.71, 4.09)1.43 (1.12, 1.82)Ref.Adjusted* HR (95% CI)1.45 (1.14, 1.83)2.35 (1.38, 4.00)1.31 (1.00, 1.70)Ref.Death, n (%)26 (4)9 (18)17 (3)63 (2)Unadjusted HR (95% CI)1.72 (0.98, 3.01)5.88 (2.07, 16.71)1.13 (0.56, 2.29)Ref.Adjusted* HR (95% CI)1.24 (0.66, 2.32)13.94 (4.30, 45.18)0.75 (0.35, 1.63)Ref.Hospitalization or death, n (%)126 (22)25 (50)101 (19)419 (14)Unadjusted HR (95% CI)1.66 (1.33, 2.07)3.01 (1.93, 4.70)1.47 (1.14, 1.89)Ref.Adjusted* HR (95% CI)1.53 (1.20, 1.94)2.84 (1.64, 4.91)1.34 (1.02, 1.77)Ref.

*Adjusted for age, sex, race, and smoking

Figure 1.

Multivariable hazard ratios for the composite outcome of hospitalization or death from COVID-19, comparing all RA and subgroups by serostatus, bone erosions, and ILD to matched comparators without RA.

Conclusion

We confirmed that RA was associated with severe COVID-19 outcomes compared to the general population. We found evidence that ILD may be an effect modifier for the relationship between RA and severe COVID-19 outcomes, but RA subgroups defined by serostatus and bone erosions had similarly elevated risk. These findings suggest that ILD or its treatment may be a major contributor to severe COVID-19 outcomes in RA.

References

[1]Bongartz, T, et al, Arthritis Rheum. 2010 Jun;62(6):1583-91.

Disclosure of Interests

None declared

Ratios of peripheral blood mononuclear cells to lncRNA steroid receptor RNA activator as new indicators of metabolic syndrome

INTRODUCTION

Metabolic syndrome (MetS) is a clinical syndrome with several characteristics. Steroid receptor RNA activator (SRA) is a long non-coding RNA (lncRNA), which can increase the expression of steroid receptor-dependent gene. This study aimed to explore the changes in metabolic parameters and the predictive value of the peripheral blood mononuclear cells (PBMCs) to SRA ratios as new indicators in subjects with and without MetS in southern China.

MATERIAL AND METHODS

There were 81 participants (39 with MetS and 42 without MetS) in this cross-sectional study. The expression of lncRNAs in PBMCs was evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The risks of SRA and PBMCs to SRA ratios contributing to the presence of MetS were estimated by univariate and multivariate logistic regression models. The area under the receiver (AUC) operating characteristic curve was employed to evaluate diagnostic accuracy.

RESULTS

MetS was positively correlated with cortisol, interleukin 6 (IL-6), white blood cell to SRA ratio (WTSR), lymphocyte to SRA ratio (LTSR), monocyte to SRA ratio (MTSR), and PBMC to SRA ratio (PTSR). A receiver operating characteristic (ROC) curve analysis was performed to assess the value of LTSR (OR: 0.722; p < 0.001) for predicting MetS. The area under the curve yielded a cut-off value of 0.483, with a sensitivity of 76.9% and a specificity of 71.4% (p < 0.001).

CONCLUSION

In summary, SRA in PBMCs may be an important biomarker of stress reaction and may play a role in vulnerability to MetS. Also, the lymphocyte to SRA ratio demonstrated high accuracy in the diagnosis of MetS.

[Bax inhibitor-1 inhibits calcification of vascular smooth muscle cells in vitro]

OBJECTIVE

To investigate the effect of Bax inhibitor-1(BI-1)on calcification of vascular smooth muscle cells(VSMCs).

METHODS

VSMCs were isolated from the thoracic aorta of SD rats.VSMCs or BI-1-overexpressing VSMCs(transfected with a BI-1-overexpressing plasmid) were cultured in normal medium or calcified medium containing β-glycerophosphate and calcium chloride, and the cell calcification was examined with Alizarin red staining.Enzyme-linked immunosorbent assay was used to determine the intracellular calcium content and alkaline phosphatase activity.The expression levels of Runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP-2) and caspase-3 were detected with Western blotting.

RESULTS

After 14 days of culture in the calcified medium, the VSMCs showed significantly reduced expression of BI-1 protein(P=0.001).BI-1 overexpression in the VSMCs caused a significant reduction of calcium level and alkaline phosphatase activities(P=0.0006) and lowered the expression levels of RUNX2 and BMP-2 (P=0.0001) in the cells.The VSMCs with induced calcification exhibited a significantly increased apoptosis rate, but BI-1 overexpression obviously inhibited VSMC apoptosis in the calcified medium (P=0.0003).

CONCLUSION

BI-1 may attenuate vascular calcification by inhibiting calcium deposition, osteogenic differentiation and apoptosis.

Associations of Suicide and Subjective Well-Being

The aim of this study is to examine relationships between suicide and subjective well-being. Correlation and regression analysis are conducted on 81 countries' aggregate data from United Nation agencies. Generally, suicide is not significantly related to life satisfaction; or negative affect, or positive social emotion, but significantly negatively related to positive self-emotion, or positive interpersonal emotion. In preventing suicide, subjective well-being's affective aspect might play a more important role than its cognitive aspect, positive affect might play a more important role than negative affect, and the personal aspect of positive affect might play a more important role than the social aspect.

[Association of metabolic syndrome with chronic kidney disease in premenopausal and postmenopausal women]

OBJECTIVE

To explore the relationship between metabolic syndrome (MS) and the risk for chronic kidney disease (CKD) in premenopausal and postmenopausal women.

METHODS

We conducted a cross-sectional study among 1346 community-based women from June to October 2012 and collected the data of personal history, lifestyle, physical measures and laboratory indicators. The diagnosis of CKD was established for an eGFR of less than 60 mL/min per 1.73 m² or albuminuria. The diagnosis of metabolic syndrome was based on the International Diabetes Federation Guide. According to an epidemiological survey in Guangdong province, women older than 48.9 years were classified as having a postmenopausal status. The prevalence of MS and CKD was determined in both the premenopausal and postmenopausal women, and the association between MS and CKD was analyzed using logistic regression models.

RESULTS

MS was significantly correlated with CKD in premenopausal women in both unadjusted analyses (OR=3.10, 95% CI: 1.32-7.28, P=0.009) and in analysis after adjustment for potential confounders (OR=4.09, 95% CI: 1.63- 10.32, P=0.003). When adjusted for diabetes, hypertension, and hyperuricemia, no correlation was found between MS and CKD in premenopausal women (OR=1.56, 95% CI: 0.31-7.63, P= 0.592); in the unadjusted analyses, MS was significantly correlated with CKD in postmenopausal women (P &lt; 0.001). After further adjustment for age, education status, current smoking, physical inactivity, and current drinking, MS was still significantly correlated with CKD (OR=2.60, 95% CI: 1.69-3.99, P &lt; 0.001). When adjusted for diabetes, hypertension, and hyperuricemia, the correlation between MS and CKD was still significant (OR=1.61, 95% CI: 1.09-2.37, P=0.018). In the unadjusted model, a high blood pressure (OR=2.77, 95%CI: 1.57-4.89, P &lt; 0.001), an elevated serum triglyceride level (OR=1.84, 95%CI: 1.16-2.90, P=0.009) and a high fast glucose level (OR=2.07, 95%CI: 1.30-3.28, P=0.002) were all significantly correlated with CKD in postmenopausal women. After adjusting for age, current smoking, current alcohol use, education status and physical inactivity, a high blood pressure (OR=2.28, 95%CI: 1.22-4.26, P=0.01), a high serum triglyceride level (OR=1.71, 95%CI: 1.03-2.86, P=0.039) and a high fast glucose (OR=2.25, 95%CI: 1.36-3.73, P=0.002) were still significantly correlated with CKD in postmenopausal women. Blood pressure, serum triglyceride level, fast glucose, serum HDL cholesterol level and central obesity were not correlated with CKD in either the unadjusted model or adjusted model in premenopausal women (P &gt; 0.05).

CONCLUSIONS

MS is correlated with CKD in both premenopausal and postmenopausal women, and the association is dependent on diabetes, hypertension, and hyperuricemia in premenopausal women but not in postmenopausal women.

Efficacy and safety of glucocorticoids for patients with IgA nephropathy: a meta-analysis

BACKGROUND

The efficacy and safety of glucocorticoids for the treatment of patients with IgA nephropathy (IgAN) remains controversial. The aim of the study is to perform a metaanalysis of randomized controlled trials to evaluate the efficacy and safety of glucocorticoids for patients with IgAN.

METHODS

We searched PubMed, EMBASE and the Cochrane Library and article reference lists of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing glucocorticoids with other non-immunosuppressive agents in patients with IgAN.

RESULTS

The present meta-analysis, including 10 RCTs and 791 patients from 12 published studies, showed that using glucocorticoids agents relatively preserves kidney function(RR 0.06, 95% CI 0.14-0.61) and plays an effective role on reducing the proteinuria(SMD, - 0.69; 95% CI 0.85 to - 0.53, p < 0.00001; heterogeneity I2 = 0%; p = 0.09) compared with a control group. Moreover, adverse events cannot be neglected, especially gastrointestinal tract (RR 3.10, 95% CI 1.37-6.98, p = 0.006; heterogeneity I2 = 0%, p = 0.86), and corticosteroid regimens in IgAN should be reviewed with regard to safety.

CONCLUSIONS

Glucocorticoids were wildly used to treat various diseases including IgAN. Meanwhile, adverse events cannot be neglected, such as gastrointestinal adverse events, infection and so on. Corticosteroid should be used with reserve, especially in those patients with hypertension and impaired renal function or older patients.

The effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH: a randomised controlled trial

OBJECTIVE

To assess the effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH.

DESIGN

A randomised controlled trial.

SETTING

A tertiary teaching hospital in China.

POPULATION

Women in the second stage of labour with no complications.

METHODS

About 443 women were randomly allocated to receive either supplemental oxygen at a flow rate of 2 l/min or a sham supplementation by nasal cannula. Healthcare providers, women and outcome assessors were blinded to allocation.

MAIN OUTCOME MEASURES

Umbilical cord artery pH and fetal heart rate (FHR) pattern.

RESULTS

Baseline characteristics were similar between the two groups. There were no significant differences between the two groups in the umbilical cord artery pH [median 7.261, interquartile range (IQR) 7.228-7.295 versus 7.266 (IQR 7.232-7.297), P = 0.64], the proportion with pH less than 7.2 [30/219 versus 34/224, P = 0.66, RR (relative risk) 0.9, 95% CI 0.57-1.42], and the proportion with normal FHR pattern (147/219 versus 153/224, P = 0.79, RR 0.98, 95% CI 0.86-1.12). Maternal partial pressure of dissolved oxygen was significantly higher in the oxygen group than in the sham group [median 150.0 mmHg (IQR 142.6-156.7) versus 112.0 (IQR 104.8-118.3), P < 0.001], whereas carbon dioxide was significantly lower in the oxygen group than in the sham group (mean difference -1.1, 95% CI -2.1 to -0.1, P = 0.03).

CONCLUSION

The use of 2 l/min maternal oxygen during the second stage of labour did not adversely affect either the umbilical artery pH or the FHR pattern distribution.

TWEETABLE ABSTRACT

No difference in abnormal fetal acid base or normal heart rate if maternal O₂ given, randomised trial finds.

Urinary Extracellular Vesicle: A Potential Source of Early Diagnostic and Therapeutic Biomarker in Diabetic Kidney Disease

OBJECTIVE

Diabetic kidney disease (DKD) has become one of the major causes of end-stage renal disease. Urinary extracellular vesicles (uEVs) contain rich biological information which could be the ideal source for noninvasive biomarkers of DKD. This review discussed the potential early diagnostic and therapeutic values of proteins and microRNAs in uEVs in DKD.

DATA SOURCES

This review was based articles published in PubMed, Embase, Cochrane, and Google Scholar databases up to November 20, 2017, with the following keywords: "Diabetic kidney disease", "Extracellular vesicle", and "Urine".

STUDY SELECTION

Relevant articles were carefully reviewed, with no exclusions applied to the study design and publication type.

RESULTS

There is no "gold standard" technology to separate and/or purify uEVs. The uEVs contain a variety of proteins and RNAs and participate in the physiological and pathological processes of the kidney. UEVs, especially urinary exosomes, may be useful biomarkers for early diagnosis and treatment to DKD. Furthermore, the uEVs has been used as a therapeutic target for DKD.

CONCLUSION

Proteins and nucleic acids in uEVs represent promising biomarker for the diagnosis and treatment of DKD.

Aging in hair follicle stem cells and niche microenvironment

Hair graying and hair loss are prominent and common characteristics of the elderly population. In some individuals these processes can significantly impact their quality of life, leading to depression, anxiety and other serious mental health problems. Accordingly, there has been much interest in understanding the complex physiological changes within the hair follicle in the aging individual. It is now known that hair follicles represent a prototypical stem cell niche, where both micro- and macroenvironmental influences are integrated alongside stem cell-stem cell and stem cell-stem niche interactions to determine hair growth or hair follicle senescence. Recent studies have identified imbalanced stem cell differentiation and altered stem cell activity as important factors during hair loss, indicating new avenues for the development of therapeutic agents to stimulate hair growth. Here, we pull together the latest findings on the hair follicle stem cell niche and the multifactorial interactions underlying the various forms of hair loss.

Variants in mitochondrial tRNA gene may not be associated with thyroid carcinoma

Thyroid cancer is a very common form of endocrine system malignancy. To date, the molecular mechanism underlying thyroid cancer remains poorly understood. Studies of oncocytic tumors have led to a hypothesis which proposes that defects in oxidative phosphorylation (OX- PHOS) may result in a compensatory increase in mitochondrial replication and gene expression. As a result, mitochondrial DNA (mtDNA) mutation analysis has become a useful tool to explore the molecular basis of this disease. Among these mutations, mitochondrial transfer RNAs (mttRNAs) are the hot spots for pathogenic mutations associated with thyroid cancer. However, due to its high mutation rate, the role of mt-tRNA variants in thyroid cancer is still controversial. To address this problem, in this study, we reassessed seven reported mt-tRNA variants: tRNA^Asp G7521A, tRNA^Arg T10411C and T10463C, tRNA^Leu(CUN) A12308G, tRNA^Ile G4292C and C4312T, and tRNA^Ala T5655C, in clinical manifestations of thyroid cancer. We first performed the phylogenetic conservation analysis for these variants; moreover, we used a bioinformatic tool to compare the minimum free energy (G) of mt-tRNA with and without mutations. Most strikingly, none of these variants caused the significant change of the G between the wild-type and the mutant form, suggesting that they may not play an important roles in thyroid cancer. In addition, we screened the frequency of the “pathogenic” A12308G alternation in 300 patients with thyroid cancer and 200 healthy controls. We found that there were five patients and three control subjects carrying this variant. It seemed that the A12308G variant may be a common polymorphism in the human population. Taken together, our study indicated that variants in mt-tRNA genes may not play active roles in patients with thyroid cancer.

The effect of gender equality on happiness: Statistical modeling and analysis

In this article, the researcher presents linear regression models that describe how five gender-equality indexes affect individuals' perceptions of well-being and happiness, controlling for their economic income and weighed by the population of the countries that contribute to the models. The logical premise of this study is that gender equality is not only favorable for women, but it is also conducive to fostering the greatest level of happiness for all people. The researcher believes that most findings confirmed this assumption and the opinion of John Stuart Mill regarding gender equality, while two exceptions are explained by social quality theory and the male breadwinner model.

Predictive Factors for the Spontaneous Recanalization of Large and Middle Cerebral Arteries after Acute Occlusion

OBJECTIVE

This study aims to investigate the predictive factors for the spontaneous recanalization of occluded arteries in patients with acute ischemic stroke.

METHODS

A total of 139 patients with consecutive acute ischemic stroke were enrolled from June 2010 to June 2013. The clinical and biochemical parameters were measured in each participant. Occlusion and recanalization of the carotid artery, the middle cerebral artery, and the vertebral and basilar arteries were identified by using computed tomographic angiography or digital subtraction angiography.

RESULTS

Among the 139 patients, 23 showed spontaneous recanalization, whereas 116 did not. In the patients with spontaneous recanalization, the proportion of atrial fibrillation was significantly lower (0% versus 29.31%, P= .01), whereas the proportion of stage 3 hypertension was significantly higher (60.87% versus 32.76%, P= .01) than that of those without recanalization. Logistic regression analysis showed that the proportion of atrial fibrillation was negatively (odds ratio [OR]: .117, 95% confidence interval [CI]: .015-.918, P= .04) associated with spontaneous recanalization, whereas the proportion of stage 3 hypertension was positively (OR: 4.316, 95% CI: 1.533-12.154, P= .01) associated with it.

CONCLUSIONS

Atrial fibrillation is associated with reduced spontaneous recanalization of the large and middle cerebral arteries in patients after acute ischemic stroke-induced occlusion, whereas stage 3 hypertension may contribute to the promotion of the recanalization.

Mitochondrial ND3 G10398A mutation: a biomarker for breast cancer

Mitochondrial DNA mutations have been found to play important roles in carcinogenesis. The most common G10398A mutation, a non-conservative amino acid substitution from Thr to Ala, seems to be involved in the tumorigenesis of breast cancer. Results from studies concerning this mutation remain inconclusive. In the current study, we first took clinical and molecular datasets from case-control studies to determine the association between the G10398A mutation and breast cancer. We further used the Phylotree to determine the haplogroups of this mutation. The frequencies of this mutation in 500 unrelated healthy controls were also screened. We found that this mutation is very common in the human population, and may be a polymorph.

Systemic lupus erythematosus patients in the low-latitude plateau of China: altitudinal influences

The current study was to investigate the features of hospitalized patients with systemic lupus erythematosus (SLE) at different altitudes. The correlation between SLE activity and altitudinal variations was also explored. Medical records of 1029 patients were retrospectively reviewed. Activity of SLE in each organ system was recorded using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). There was no significant correlation between SLE activity and altitudes (r = 0.003, p = 0.159). Age at onset for SLE patients at high altitudes was significantly younger than that at low and moderate altitudes (p = 0.022 and p = 0.004, respectively). Age at SLE admission at low altitudes was significant older than those at moderate and high altitudes (p = 0.011 and p < 0.001, respectively). Patients at high altitudes had shorter duration from disease onset to admission than those at moderate altitudes (p = 0.009). Incidence of Sm antibodies-positive for resident patients at high altitudes was 36.4%, which were higher than that at moderate altitudes (p = 0.003). We found increasing trends of CNS activity in active patients; immunological and renal activities in inactive patients were correlated with elevated altitudes (p = 0.024, p = 0.004, p = 0.005), while arthritis scores in active patients showed the tendency of decreasing with the rise of elevation (p = 0.002). Hemoglobin level, red blood cell and platelet counts at high altitudes were significantly lower than those at low altitudes (p < 0.05, respectively). There was no significant difference in hemoglobin level between moderate- and low-altitude groups (p > 0.05). No significant difference in platelet counts between moderate- and high-altitude groups was observed (p > 0.05). Our findings suggest that some clinical features, laboratory tests and activity of main organs in SLE are influenced by altitudes. Furthermore, organ activities of active and inactive SLE patients have different patterns of altitudinal variations. These distinctive variations likely reveal that peculiar environmental factors at high altitudes can affect the development of SLE.

Chemokine-like factor 1 (CLFK1) is over-expressed in patients with atopic dermatitis

Background: Human chemokine-like factor 1 (CKLF1), a recently discovered chemokine, has a broad spectrum of biological functions in immune-mediated diseases. It is highly expressed on Th2 lymphocytes and is a functional ligand for human CCR4. CKLF1 has a major role in the recruitment and activation of leucocytes, which plays an important role in the pathogenesis of allergic diseases. The present study was designed to determine the expression of CKLF1 in skin and serum in patients with atopic dermatitis (AD).

Methods: The CKLF1 protein expression in skin lesion was analyzed by immunohistochemistry and ELISA. The mRNA expression of CKLF1 in skin lesion was detected by Real-time PCR. The serum levels of CKLF1, IgE, eotaxin, IL-4, IL-5, and IL-13 were measured by ELISA.

Results: Histopathological changes in the skin of AD patients showed local inflammation with epidermal thickening and significant inflammatory cellular infiltration. Immunohistochemistry results demonstrated that CKLF1-staining positive cells were located in the epidermal and dermis, and that the CKLF1 expression in AD patients was significantly higher than that in normal control. The CKLF1 mRNA expression in AD patients was significantly higher than that in healthy controls. Serum CKLF1 and IgE levels were significantly increased in AD patients, as were the serum levels of IL-4, IL-5, IL-13 and eotaxin.

Conclusions: Both CKLF1 protien and mRNA levels are overexpressed in the skin lesion of AD patients, along with an increase in serum CKLF1 level, indicating that CKLF1 may play an important role in the development of atopic dermatitis.

Effects of cigarette smoke extracts on the growth and senescence of skin fibroblasts in vitro

Epidemiological studies have shown that cigarette smoke (CS), a very common environmental factor, plays an important role in skin aging. Although some in vivo studies have suggested that CS affects skin aging, the detailed effects of CS on skin cells in vitro remain largely unknown. In this study, we investigated the effects of cigarette smoke extract (CSE) on the growth, proliferation, and senescene of skin fibroblasts and the possible mechanism underlying these effects. Primary cultured human fibroblasts were exposed to a range of concentrations of CSE. Cell viability and cell proliferation after CSE exposure were analyzed with the methyl thiazolyl tetrazolium (MTT) assay and bromodeoxyuridine incorporation assay, respectively. Growth curves of fibroblasts exposed to different concentrations of CSE were developed and prolonged CSE-exposed cells were observed. Morphological and ultrastructural changes in fibroblasts were assessed by inverted light microscopy and transmission electron microscopy (TEM). Dying cells were stained with senescence-associated β-galactosidase (SA β-gal). Intracellular reactive oxygen species (ROS) levels, superoxide dismutase (SOD) activity, and glutathione peroxidase (GSH-Px) activity were determined by a colorimetric method. We found that proliferative capacity and growth were inhibited by CSE exposure in a dose- and time-dependent manner. Fibroblasts exposed to even low concentrations of CSE for a long period of time (5 passages) showed significantly increased SA β-gal activity and typical features of aging cells. Meanwhile, CSE inhibited superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and augmented ROS levels. Our observations suggest that CSE exposure impairs fibroblast growth and proliferation and leads to features similar to those seen in senescent cells. Oxidative stress injury and inhibition of antioxidant defense activity may be involved in CSE-induced fibroblast senescence.

Is the step-up therapy of topical 5-aminolevulinic acid photodynamic therapy effective and safe for the patients with recalcitrant facial flat wart?

Facial flat wart, caused by human papilloma virus type 3 and less often, type 10, 27, and 41, often brings many cosmetic problems to children and young adults. Considering the disturbing cosmetic problem, the treatment of facial flat wart is always frustrating and often unsuccessful, although there are many treatment modalities. Considering the possible serious side effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT), we designed step-up therapy of ALA-PDT on different clinical phases of facial flat wart. As a new protocol of ALA-PDT, we found the step-up therapy of ALA-PDT could also receive excellent effects with the lower side effects. Meanwhile, the tolerance of patients to ALA-PDT could improve with subsequent treatment sessions and escalating doses of ALA-PDT.

Socio-demographic determinants of aflatoxin B1-lysine adduct levels among pregnant women in Kumasi, Ghana

OBJECTIVES

Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse birth outcomes and poor infant development, no study has investigated the socio-demographic and economic determinants of aflatoxin levels among pregnant women living in sub-Saharan Africa.

DESIGN

A cross-sectional study was conducted among 785 pregnant women in Kumasi. Aflatoxin B1 lysine adduct levels (AF-ALB) were determined by High Performance Liquid Chromatography. Analysis of variance was used to determine mean log AF-ALB levels and significance of differences in these levels according to socio-demographic variables. Logistic regression was used to identify independent associations of socio-demographics with having AF-ALB levels (≥ 11.34 pg/mg; upper quartile).

RESULTS

AF-ALB levels ranged from 0.44 pg/mg to 268.73 pg/mg albumin with a median level of 5.0 pg/mg. Bivariate analyses indicates that mean ln AF-ALB as well as the percent of women having high AF-ALB levels (≥ 11.34 pg/mg; upper quartile) were inversely associated with indices of higher socioeconomic status: higher education and income, being employed and having a flush toilet. Higher income, being employed, having one child (verses no children) and having a flush toilet (verses no toilet facilities) were each independently associated with a 30-40% reduced odds of high AF-ALB levels.

CONCLUSIONS

Additional research is needed to investigate how socio-demographic and economic factors interact to influence aflatoxin ingestion by individuals in regions with high aflatoxin crop contamination. This knowledge can be used to formulate and implement policies that will reduce exposure of women and their unborn children to these toxins.

Characterization of a small molecule inhibitor of tumor necrosis factor-alpha production

BACKGROUND

Numerous studies have shown that reducing the level of tumor necrosis factor-alpha (TNFα) through the use of anti-TNF antibodies or soluble TNF receptor is a safe and efficacious treatment to inflammatory diseases such as rheumatoid arthritis. Therefore, novel approaches to achieve this outcome are desired. The aim of this study was to investigate the characterization of a small molecule inhibitor, Y316, which blocks TNF mRNA upregulation and TNF production by lipopolysaccharides (LPS) stimulated monocytes.

METHODS

Peripheral blood mononuclear cells (PBMC) from healthy volunteers were plated in 24-well plates and stimulated with LPS (1 µg/ml), phorbol-12-myristate-13-acetate (PMA) (100 ng/ml), zymosan (10 µg/ml) and Tsst (100 ng/ml). Supernatants were collected after 4-hour culture at 37°C, and quantitative determination of TNFα, interleukin-1β (IL-1β), IL-6, IL-8, IL-10 and IL-2 production in the supernatants was performed by colorimetric enzyme-linked immunosorbent assay (ELISA). Total RNA of PBMC was isolated and cytokine mRNA quantitation was performed by using a RNA level measuring kit (R & D Systems). PBMC were pretreated with Y316 (10 µmol/L, 1 µmol/L, 0.1 µmol/L, 0.01 µol/L and 0.001 µmol/L) or dimethyl sulfoxide at 37°C for 10 minutes, and then stimulated with LPS or PMA, protein concentrations of p44.42, IKBα, P38 and Jun NH2-terminal kinase were determined by Western blotting. Cyclic adenosine-3',5'-monophosphate (cAMP) of PBMC was measured by enzyme immunoassay kit (Amersham Pharmacia Biotech).

RESULTS

Y316 blocked TNF production and inhibited the upregulation of TNF mRNA levels in response to LPS, and also prevented the production of IL-1 and IL-6. In contrast, Y316 augmented the production of IL-10 in LPS-stimulated monocytes. Y316 failed to prevent the production of IL-2 and TNF in antigen-stimulated T cells, suggesting that its effects may be cell-type specific. Y316 prevented the phosphorylation and activation of the MAPK, ERK, and therefore appeared to mediate its effects on TNF by acting at an early point in the signaling cascade induced in response to LPS. There was no effect of Y316 on cAMP levels either alone or in the presence of LPS.

CONCLUSIONS

Y316 appears to be a small molecule inhibiting TNF production, which may act via a novel mechanism. Identification of the target of Y316 may lead to the development of alternative strategies for achieving selective cytokine inhibition.

Cannabinoid 1 receptors modulate intestinal sensory and motor function in rat

BACKGROUND

Cannabinoid receptors are involved in visceral pain perception and control of intestinal motility in vivo. The underlying mechanisms are not well characterized. We aimed to determine whether the cannabinoid-1 (CB(1)) receptor modulates intestinal afferent nerve discharge and the peristaltic reflex.

METHODS

Rats were anesthetized and intestinal segments were removed. Afferent nerve discharge from a mesenteric nerve was investigated in vitro in the presence of the CB(1) antagonist SR 141716A or the CB(1) agonist WIN 55212-2. The myenteric peristaltic reflex was induced by electrical field stimulation and influence of SR 141716A or WIN 55212-2 was recorded.

KEY RESULTS

Afferent nerve discharge to the algesic mediator bradykinin was reduced to 11 +/- 5.1 imp s(-1) following pretreatment with SR 141716A and unchanged after WIN 55212-2 compared to 63 +/- 15.4 imp s(-1) in controls. At maximum distension pressure (80 cmH(2)O) during ramp distension, 92 +/- 12.4 imp s(-1) were reached following SR 141716A compared to 260 +/- 13.2 in vehicle controls and 227 +/- 15.4 in WIN 55212-2 pretreated animals. In contrast, afferent discharge to 5-HT (500 micromol L(-1)) was increased to 75 +/- 24.6 imp s(-1) following WIN 55212-2 compared to 18 +/- 5.9 imp s(-1) in controls, whereas SR 141716A had no effect. Ascending neuronal contractions were dose-dependently attenuated in the presence of SR 141716A and latency of these contractions was reduced. WIN 55212-2 had opposite effects that were abolished by SR 141716A.

CONCLUSIONS & INFERENCES

Activation of the CB(1) receptor differentially alters afferent intestinal nerve sensitivity to bradykinin, 5-HT, and noxious mechanical distension, while it strengthens ascending neuronal contractions. Further studies are needed to determine the physiological relevance of these observations.

Potential therapy of Fc-antigen combination-encoding DNA vaccination in mouse allergic airway inflammation

Vaccination with allergen-encoding DNA has been proposed as having potential for allergen-specific immunotherapy. In this study, we examine the therapeutic effect of allergen-encoding DNA vaccination directly to dendritic cells (DCs) on allergen-induced allergic airway inflammation in a mouse model and explore potential mechanism. Ovalbumin (OVA)-sensitized and challenged mice were immunized with DNA vaccine and received bronchoalveolar lavage (BAL) 1 day after the last challenge, to measure BAL levels of interleukin (IL)-4, IL-5, interferon (IFN)-gamma and differential cell count. Pulmonary DCs and Spleen DCs were purified and sorted according to the expression of CD(11c) (+)CD(80) (+) and CD(11c) (+)CD(86) (+) co-stimulatory molecules. Our data demonstrated that DNA vaccine therapy with OVA-Fc-pcDNA(3.1) significantly prevented OVA-increased levels of IL-4, IL-5 and the percentage of eosinophils and OVA-decreased level of IFN-gamma. OVA-Fc-pcDNA(3.1)-treated mice had less severity of airway inflammation, and lower expression of CD(11c) (+)CD(80) (+) and CD(11c) (+)CD(86) (+) on pulmonary DCs, as compared with animals with OVA-pcDNA(3.1,) pcDNA(3.1) and OVA respectively. DNA vaccine encoding both Fc and OVA was shown to be more effective than DNA vaccine encoding OVA alone. Our data indicate that Fc-antigen combination-encoding DNA vaccination has better preventive effects on antigen-induced airway inflammation by regulating DCs, and may be a new alternative therapy for asthma.

[Sequences variation and classification of B-hordein genes in hull-less barley from Qinghai-Tibet Plateau]

The goal of this study is to understand the evolution relationship of the members of B-hordein gene family in hull-less barley by analysis of their structure and to explore their utility in grain quality improvement. Six copies of B-hordein gene (Hn1-Hn3, Hn7-Hn9) were cloned from six hull-less barley cultivars collected from Qinghai-Tibet Plateau and molecularly characterized. Comparison of their predicted polypeptide sequences with the published suggested that they all share the same basic protein structures. In addition, we found that the C-terminal end sequences of all B-hordeins shared a similar feature. In the six clones and the other three published (Hn4, Hn5 and Hn6) from hull-less barley, Hn2 and Hn7 contained identical C-terminal end sequence DIMPVDFWH, Hn3, Hn4, Hn5, Hn8 and Hn9 also shared the common sequence DIMPPDFWH, which was similar to that of a B-hordein reported previously. Both Hnl and Hn6 exhibited differences in their C-terminal end sequences, and they clustered into different subgroups. The B-hordeins with identical C-terminal end sequences were clustered into a same subgroup, so we believe that B-hordein gene subfamilies possibly can be classified on the basis of the conserved C-terminal end sequences of predicted polypeptide. Phylogenetic analysis also indicated that there is a relatively weak identity between our predicted B-hordeins and those reported from H. chilense and H. brevisubulatum. All of our nine predicted B-hordeins were clustered together and other B-hordeins formed another cluster. The possible use of these genes in relation to the barley quality is discussed.

Blocking Notch1 signaling by RNA interference can induce growth inhibition in HeLa cells

The Notch proteins constitute a family of transmembrane receptors that play a pivotal role in cellular differentiation, proliferation, and apoptosis. RNA interference of Presenilin1 (PS1) and Notch1 was carried out in this research to determine whether it could block Notch signaling and induce growth inhibition in HeLa cells. We transfected synthesized target small interfering RNA (siRNA) into HeLa cells, and blocking of Notch signaling was detected by C-promoter binding factor-1 (CBF1) reporter. We then conducted cell proliferation assay. Cells transfected with PS1 and Notch1 siRNA showed great inhibition in proliferation compared to the controls in vitro and in vivo. We conclude that RNA interference of PS1 or Notch1 can block Notch signaling and consequently induce growth inhibition of HeLa cells.