[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.

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

[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.

The Prediction for COVID-19 Outbreak in China by using the Concept of Term Structure for the Turning Period

This study aims to develop a general framework for predicting the duration of the Turning Period (or Turning Phase) for the COVID-19 outbreak in China that started in late December 2019 from Wuhan. A new concept called the Term Structure for Turning Period (instead of Turning Point) is used for this study, and the framework, implemented into an individual SEIR (iSEIR) model, has enabled a timely prediction of the turning period when applied to Wuhan's COVID-19 epidemic, and provided the opportunity for relevant authorities to take appropriate and timely actions to successfully control the epidemic. By using the observed daily COVID-19 cases in Wuhan from January 23, 2020 to February 6 (and February 10), 2020 as inputs to the framework it allowed us to generate the trajectory of COVID-19 dynamics and to predict that the Turning Period of COVID-19 outbreak in Wuhan would arrive within one week after February 14. This prediction turned out to be timely and accurate, which has provided adequate time for the government, hospitals and related sectors and services to meet peak demand and to prepare aftermath planning. We want to emphasize that emergency risk management entails the implementation of an emergency plan, where timing the Turning Period is key to express a clear timeline for effective actions. Our study confirms the observed effectiveness of Wuhan's Lockdown and Isolation control program imposed since January 23, 2020 to the middle of March, 2020 and resulted in swiftly flattened epidemic curve, and Wuhan's success offers an exemplary lesson for the world to learn in combating COVID-19 pandemic.

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.

Use of a Novel Nonparametric Version of DEPTH to Identify Genomic Regions Associated with Prostate Cancer Risk

BACKGROUND

We have developed a genome-wide association study analysis method called DEPTH (DEPendency of association on the number of Top Hits) to identify genomic regions potentially associated with disease by considering overlapping groups of contiguous markers (e.g., SNPs) across the genome. DEPTH is a machine learning algorithm for feature ranking of ultra-high dimensional datasets, built from well-established statistical tools such as bootstrapping, penalized regression, and decision trees. Unlike marginal regression, which considers each SNP individually, the key idea behind DEPTH is to rank groups of SNPs in terms of their joint strength of association with the outcome. Our aim was to compare the performance of DEPTH with that of standard logistic regression analysis.

METHODS

We selected 1,854 prostate cancer cases and 1,894 controls from the UK for whom 541,129 SNPs were measured using the Illumina Infinium HumanHap550 array. Confirmation was sought using 4,152 cases and 2,874 controls, ascertained from the UK and Australia, for whom 211,155 SNPs were measured using the iCOGS Illumina Infinium array.

RESULTS

From the DEPTH analysis, we identified 14 regions associated with prostate cancer risk that had been reported previously, five of which would not have been identified by conventional logistic regression. We also identified 112 novel putative susceptibility regions.

CONCLUSIONS

DEPTH can reveal new risk-associated regions that would not have been identified using a conventional logistic regression analysis of individual SNPs.

IMPACT

This study demonstrates that the DEPTH algorithm could identify additional genetic susceptibility regions that merit further investigation. Cancer Epidemiol Biomarkers Prev; 25(12); 1619-24. ©2016 AACR.

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.

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.

Supercomputing enabling exhaustive statistical analysis of genome wide association study data: Preliminary results

Most published GWAS do not examine SNP interactions due to the high computational complexity of computing p-values for the interaction terms. Our aim is to utilize supercomputing resources to apply complex statistical techniques to the world's accumulating GWAS, epidemiology, survival and pathology data to uncover more information about genetic and environmental risk, biology and aetiology. We performed the Bayesian Posterior Probability test on a pseudo data set with 500,000 single nucleotide polymorphism and 100 samples as proof of principle. We carried out strong scaling simulations on 2 to 4,096 processing cores with factor 2 increments in partition size. On two processing cores, the run time is 317h, i.e. almost two weeks, compared to less than 10 minutes on 4,096 processing cores. The speedup factor is 2,020 that is very close to the theoretical value of 2,048. This work demonstrates the feasibility of performing exhaustive higher order analysis of GWAS studies using independence testing for contingency tables. We are now in a position to employ supercomputers with hundreds of thousands of threads for higher order analysis of GWAS data using complex statistics.

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.

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.

LBP inhibitory peptide reduces endotoxin-induced macrophage activation and mortality

OBJECTIVE AND DESIGN

The aim of this study was to investigate whether P12, a lipopolysaccharide (LPS)-binding protein (LBP) inhibitory peptide could reduce LPS induced inflammation in vitro and in vivo.

MATERIAL AND METHODS

Human monocyte-like cell line (U937 cells) was grown in RPMI 1640 and stimulated with PMA in order to induce differentiation to the macrophage stage. A total of 70 Kunming mice (8-12 wk old) were used in our experiments. The effects of P12 on the binding of LPS to U937 cells and alveolar macrophages (AMs) were determined by flow cytometric analysis. Nuclear factor kappa B (NF-kappa B) translocation was evaluated with subunit P65 by Western blotting. The production of tumor necrosis factor-alpha (TNF-alpha), alanine transaminase (ALT), and nitric oxide (NO) as measured by ELISA, enzymatic activity assay, and enzymatic assay with nitrate reductase. Differences among groups were determined using one-way ANOVA test and Fisher exact test.

TREATMENT

U937 cells were treated with LPS, LBP, and indicated concentrations of P12. Mice were administered LPS intraperitoneally and P12 via the tail vein.

RESULTS

P12 inhibited the binding of FITC-conjugated LPS (FITC-LPS) to U937 cells and AMs. NF-kappa B translocation and the production of TNF-alpha, ALT, and NO induced by LPS was also significantly suppressed by P12. Furthermore P12 protected mice from LPS-induced death.

CONCLUSIONS

The results suggest that blockade of LBP at inflammation sites might attenuate LPS-induced circulatory shock. This results in a beneficial effect in a mouse model of endotoxemia.

Robust structure from motion estimation using inertial data

The utility of using inertial data for the structure-from-motion (SfM) problem is addressed. We show how inertial data can be used for improved noise resistance, reduction of inherent ambiguities, and handling of mixed-domain sequences. We also show that the number of feature points needed for accurate and robust SfM estimation can be significantly reduced when inertial data are employed. Cramér-Rao lower bounds are computed to quantify the improvements in estimating motion parameters. A robust extended-Kalman-filter-based SfM algorithm using inertial data is then developed to fully exploit the inertial information. This algorithm has been tested by using synthetic and real image sequences, and the results show the efficacy of using inertial data for the SfM problem.

[Construction of a subtracted cDNA library of differentially expressed genes in human normal liver tissue and primary hepatocellular carcinoma tissue]

OBJECTIVE

To construct a subtracted cDNA library of differentially expressed genes in human normal liver tissue and primary hepatocellular carcinoma (HCC) tissue.

METHODS

Using the suppression subtractive hybridization (SSH), a novel technique has been described recently. cDNA fragments of missing or low expressing tumor suppressor genes in HCC tissue were isolated using paracancerous normal liver tissue and HCC tissue as targets. Then these cDNA fragments were directly inserted into T/A cloning vector to set up the subtractive library. Amplification of the library was carried out with transformation of E.coli by high voltage electroperforation. One hundred positive bacteria clones were randomly picked and identified using enzyme restriction method.

RESULTS

The amplified library contained more than 4,000 positive bacteria clones. Random analysis of 100 clones with enzyme restriction method showed that all clones contained 200-600 bp inserts.

CONCLUSIONS

A subtracted cDNA library of differentially expressed genes in human normal liver tissue and HCC tissue is constructed successfully with SSH and T/A cloning techniques. The library is efficient and lays solid foundation for screening and cloning new and specific missing or low expressing tumor suppressor genes of HCC.

[Changes of L-selectin expression on polymorphonuclear leukocytes and its role during polymorphonuclear leukocytes sequestration in lungs of rats with acute lung injury]

OBJECTIVE

To explore the changes of L-selectin protein expression on peripheral blood polymorphonuclear leukocytes (PMN) and their role during PMN sequestration in the lungs of rats with acute lung injury (ALI).

METHODS

The model of ALI in rat was established by intravenous injection of E. Coli endotoxin (ET). The protein expression of L-selectin on peripheral blood PMNs was measured by immunofluorescence and flow cytometry. Myeloperoxidase (MPO) enzyme analysis and histology were employed to estimate the quantity of PMN sequestration in lungs of rats during ALI.

RESULTS

(1) The protein expression of L-selectin on PMN after injection of ET (7.8 +/- 1.6) was all significantly lower than that in control group (10.5 +/- 2.1, P < 0.05). (2) MPO activity increased significantly after injection of ET in comparison with the control group [0.069 +/- 0.011) U/mg lung tissue, P < 0.01]. The difference was not significant between the fucodin treated 5 min group [(0.391 +/- 0.071) U/mg lung tissue] and ET-treated 5 min group [(0.359 +/- 0.074) U/mg lung tissue]. But MPO activity was significantly lower in fucodin-treated 15 min group [(0.396 +/- 0.061) U/mg lung tissue] than that in ET-treated group at same time point [(0.490 +/- 0.069) U/mg lung tissue, P < 0.05].

CONCLUSIONS

(1) In physiological state, L-selectin are consistently expressed on the surface of PMN membrane. The protein expression of L-selectin on PMNs reduces rapidly after injection of ET and is the lowest at 15 min, then gradually increases. (2) The early stage of PMN sequestration in lungs is not dependent on L-selectin, but L-selectin is still important for maintaining a continual PMN sequestration in lungs of rats with ALI.

[The effect of monocarboxylate transporter gene on the regulation of pHi and growth character in cancer cells]

OBJECTIVE

To study the influence of the first subtype of monocarboxylate transporter (MCT1) gene on pHi regulation, lactate transport and cell growth in tumor cells.

METHODS

(1) With RT-PCR technique, MCT1 cDNA fragment was cloned from human lung cancer cells A549, and the cloned fragment MCT1 was reversely inserted into the vector pLXSN to acquire antisense expression recombinant vector pLXSN-MCT1. (2) pLXSN, pLXSN-MCT1 were respectively introduced into the A549 cells by electroporation. The transfected A549 cell resistant to G418 drug was selected as positive clones and proved by PCR. The changes of intracellular pH and lactate in the transfected A549 cells were detected by spectrophotometric method. Cell growth was studied by cell growth curve.

RESULTS

(1) The cloned fragment was in the length of 640 bp and successfully bound to pLXSN. It was also proved to be the objective one by DNA sequencing. (2) Intracellular pH and lactate were remarkably decreased in the cells transfected pLXSN-MCT1, comparing to A549 cells without transfection (P < 0.001). The growth of A549 cells transfected pLXSN-MCT1 was also inhibited remarkably.

CONCLUSION

MCT1 gene could play an important role in pHi regulation, lactate transport and cell growth in tumor cells.

Recovery of heavy metals and stabilization of spent hydrotreating catalyst using a glass-ceramic matrix

Chemical analysis of spent Co/Mo/gamma Al(2)O(3) catalyst revealed the presence of carbon, molybdenum, sulfur, vanadium and cobalt at levels of 16.0, 10.9, 7.3, 4.6 and 4.0 wt.%, respectively. It was found that calcination at 500 degrees C provides an effective solution for the removal of carbon and sulfur and this generates the oxide form of the heavy metals. The removal of these heavy metals can be achieved through a two-stage leaching process. During the first stage, in which concentrated ammonia is used and it has been found that this process can be successful in removing as much as 83% (w/v) Mo. In a second stage, it was found that using 10% (v/v) of sulfuric acid, it was possible to account for up to 77% (w/v) Co and 4% (w/v) Mo removal. Leaching test results indicated that the vanadium present in the heated spent catalyst was almost stabilized but the molybdenum and cobalt were not. The combination of two solid wastes, ladle furnace slag (LFS) and treated residue of spent catalyst, could be used for making a high value-added anorthite glass-ceramic materials. Further leaching tests showed that ceramic glass materials provided a very effective method of Co, Mo and V heavy metals stabilization resulting in a product with a possible commercial value.

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial

BACKGROUND

This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China.

METHODS

Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke).

RESULTS

Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05).

CONCLUSIONS

Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

[The influence of dexamethasone on mRNA expression of interleukin-5, interleukin-3 and granulocyte-macrophage colony-stimulating factor receptors in eosinophils of guinea pig asthma model]

OBJECTIVE

To investigate the iufluence of dexamethasone (DM) on expression of interleukin-5 receptor alpha(IL-5R alpha), interleukin-3 receptor alpha (IL-3R alpha), granulocyte-macrophage-colony-stimulating factor receptor alpha(GM-CSFR alpha) and common beta receptor (beta cR) in bronchalveolar lavage fluid (BALF) eosinophils in guinea pig asthma model, and to study the mechanism of promotion effect of steroid on eosinophil apoptosis.

METHODS

18 guinea pigs were divided into three groups randomly, normal control group, asthma group and DM-treated group. Asthma models of guinea pig were sensitized by ovalbumin(OVA). Hypodense EOS (HEOS) and normodense EOS (NEOS) were purified from BALF by gradients of percoll. Apoptosis was detected by method of TdT-mediated dUTP nick end labeling. The mRNA expression of IL-5R alpha, IL-3R alpha, GM-CSFR alpha and common beta receptor (beta cR) in eosinophils were measured by RT-PCR and in situ hybridization.

RESULTS

Apoptosis of HEOS and NEOS in asthma group(4.0 +/- 2.0 and 3.0 +/- 2.0, respectively) were significanteylower than normal group(8.0 +/- 2.0 and, 7.0 +/- 2.0 respectively, P < 0.01), while the numbers of EOS cells (75.2 +/- 12.6 and 50.7 +/- 11.2, respectively) were significantly higher than normal group (4.8 +/- 1.5 and 9.5 +/- 2.6, respectively, P < 0.01). The BALF HEOS and NEOS of asthma group were remarkably reduced after DM treatment (14.8 +/- 8.0 and 20.0 +/- 7.0, respectively, P < 0.01), Eosinophils apoptosis in DM-treated group (24.0 +/- 5.0 and 22.0 +/- 4.0, respectively) was remarkably higher than those in asthma group (P < 0.01); The expressions of IL-5R alpha, IL-3R alpha, GM-CSFR alpha mRNA of BALF EOS of asthma group were significantly lower, but the expression of beta cR mRNA was significantly higher than those of normal group(P < 0.01, 0.05). The expressions of IL-5R alpha, IL-3R alpha, GM-CSFR alpha mRNA in EOS of DM-treated group were significantly higher, while the expression of beta cR mRNA were significantly lower than those of asthma group (P < 0.01, 0.05).

CONCLUSIONS

DM promote the apoptosis of BALF EOS of guinea pigs asthma models. and reduce EOS infiltration in lung of guinea pigs asthma models. It also decreased the effect of IL-5, IL-3 and GM-CSF and promoted the apoptosis of lung EOS through inducing the mRNA expression of their specific alpha chain and reducing the mRNA expression of the common beta chain.

[Impact of quantitative and qualitative pathogen culture on the outcome of ventilator-associated pneumonia]

OBJECTIVE

To evaluate the impact diagnostic methods with either quantitative culture (QC) or qualitative routine culture (RC) on the outcome of VAP.

METHODS

A prospective, controlled clinical trial in 93 consecutive VAP episodes of 31 patients receiving mechanical ventilation was conducted. VAP episodes were randomly and crossly divided into QC (43 episodes, underwent FOB-PSB-QC) and RC group (50 episodes, underwent ETA-RC). Empirical antibiotic treatment was given according to the attending physician and modified according to the results of culture and sensitivity. The outcomes of VAP were assessed.

RESULTS

There were no differences with regard to mortality, super-infection rate, antibiotic resistance rate and cost of antibiotics when comparing QC versus RC diagnostic methods and management based on two diagnostic strategies. Inappropriate initial empirical antibiotic treatment led to a higher mortality (17.7%) when compared with those with appropriate treatment.

CONCLUSION

The present study demonstrates that the outcome of VAP is probably more dependent on the adequacy of the initial antibiotic treatment than on the use of either diagnostic sampling.