OP0095 A DECISION MODEL OF LABIAL GLAND BIOPSY BASED ON B-MODE ULTRASONOGRAPHY WITH SHEAR-WAVE ELASTOGRAPHY IN PATIENTS WITH SUSPECTED SJÖGREN’S SYNDROME

Background:

Focal lymphocytic sialadenitis defined as focus score (FS) ≥1 on labial gland (LG) biopsy plays an integral role in various classification criteria of Sjögren’s syndrome (SS). However, suspected patients often hesitate to receive a biopsy; and rheumatologists hope a decision for biopsy based on a high predicted incidence of FS≥1, or against biopsy based on an absolutely low predicted incidence.

Objectives:

To build a decision model of LG biopsy based on B-mode ultrasonography (US) with shear-wave elastography (SWE) in patients with suspected SS.

Methods:

Patients who had at least one symptom of oral dryness (based on AECG questions) or had anti-SSA positive were recruited and signed a written informed consent. Bilateral parotid (PG) and submandibular glands (SMG) were examined with B-mode US which graded the echostructure of each gland on a scoring system scaled 0 to 4 (US score), and SWE which described the elasticity of glands. Then LG biopsy was performed.

Results:

(1)Ninety-one patients whose mean age was 43±15 years were enrolled and 93% of them were female. Anti-SSA was detected in 77 patients (85%) and 28 patients (31%) showed unstimulated whole saliva flow rate (USFR)≤0.1mL/mim. There were 57 patients (63%) showing FS≥1 on LG biopsy. Sixty-three patients (69%) were classified as primary SS, 10 patients (10%) were secondary SS, 18 patients (20%) were uCTD and one patient was RA without SS.

(2)US scores were equal between PG and SMG in 59 patients (65%), while the rest patients showed different US scores between two glands: 7 patients (8%) showed higher US scores in PG and 25 patients (27%) showed higher scores in SMG. In each pair of glands US scores were equal. SWE values in PG or SMG of US score 1, 2 or 3 were significantly higher than those of US score 0, while SWE values in glands of US score 4 became declined and showed no significant difference from those with US score 0 (Figure 1A).

(3)Heatmap showed US scores in either major salivary gland of patients with FS≥1 on LG biopsy were significantly higher than those with FS<1 (all p<0.001, Figure 1B). ROC curve showed a total US score (including bilateral PG and SMG) ≥9 and a total SWE value (including bilateral PG and SMG)≥30 could significantly recognize patients with FS≥1, respectively with specificity of 100% and 93% (Figure 1C). In this cohort, among 51 patients with a total US score ≥9 and/or a total SWE value≥30, 49 patients (96%) showed FS≥1 on LG biopsy; while two outliers showed total US scores were both 8 although combined SWE values≥30. Other 29 patients showed total US scores≤6 with total SWE values <30 and only one patient (3%) showed FS≥1 on LG biopsy. The remaining 11 patients showed total US scores were 8 with total SWE values <30 and 64% of them (n=7) showed FS≥1.

Conclusion:

A preliminary decision model of LG biopsy based on B-mode US with SWE in patients with suspected SS were built in Table 1. For example, rheumatologists should reassess the need for biopsy if the incidence of FS≥1 would be <5%. Another cohort of patients with suspected SS is needed for further validation.

Table 1.

A preliminary decision model of LG biopsy based on B-mode US with SWE in patients with suspected SS

Algorithm*Comments on the decision of LG biopsyA total US score≥9 and/or a total SWE≥30The specificity of FS≥1 on biopsy is >93%. Biopsy is recommended. In some special cases (e.g. contraindicated to biopsy), this item is a potential alternative to LG biopsy.A total US score 7~8 with a total SWE <30It is hard to predict the result of FS, so biopsy is strongly recommended.A total US score≤6 with a total SWE <30The incidence of FS≥1 would be <5%. Rheumatologists should reassess the need for biopsy.

References:

None

Disclosure of Interests:

None declared

Molecular mapping and candidate gene analysis for resistance to powdery mildew in Cucumis sativus stem

Powdery mildew (PM) of cucumber (Cucumis sativus), caused by Podosphaera xanthii, is a major foliar disease worldwide and resistance is one of the main objectives in cucumber breeding programs. The resistance to PM in cucumber stem is important to the resistance for the whole plant. In this study, genetic analysis and gene mapping were implemented with cucumber inbred lines NCG-122 (with resistance to PM in the stem) and NCG-121 (with susceptibility in the stem). Genetic analysis showed that resistance to PM in the stem of NCG-122 was qualitative and controlled by a single-recessive nuclear gene (pm-s). Susceptibility was dominant to resistance. In the initial genetic mapping of the pm-s gene, 10 SSR markers were discovered to be linked to pm-s, which was mapped to chromosome 5 (Chr.5) of cucumber. The pm-s gene's closest flanking markers were SSR20486 and SSR06184/SSR13237 with genetic distances of 0.9 and 1.8 cM, respectively. One hundred and fifty-seven pairs of new SSR primers were exploited by the sequence information in the initial mapping region of pm-s. The analysis on the F₂ mapping population using the new molecular markers showed that 17 SSR markers were confirmed to be linked to the pm-s gene. The two closest flanking markers, pmSSR27and pmSSR17, were 0.1 and 0.7 cM from pm-s, respectively, confirming the location of this gene on Chr.5. The physical length of the genomic region containing pm-s was 135.7 kb harboring 21 predicted genes. Among these genes, the gene Csa5G623470 annotated as encoding Mlo-related protein was defined as the most probable candidate gene for the pm-s. The results of this study will provide a basis for marker-assisted selection, and make the benefit for the cloning of the resistance gene.

[Pathogens and clinical characteristics of bacterial infection in hematology department between 2010 and 2014]

OBJECTIVE

To analyze the characteristics of distribution and drug resistance of bacterial infection in several different parts of hematology department inpatients of Anhui Provincial Hospital from January 2010 to December 2014, including patients who had received hematopoietic stem cell transplantation (HSCT).

METHODS

Anti-microbial susceptibility test was done by Kirby-Bauer method and automated systems and the data were analysed by WHONET 5.6 software.

RESULTS

A total of 3 312 copies of inspection samples were analyzed, including 2 716 (82%) blood samples and other 596 specimens (18%). 634 bacterial strains were isolated from 3 312 samples (19.14%) including 488 samples (76.97%) from blood culture. 427 (67.35%) bacterial strains were gram-negative, and the other 207 (32.65%) were gram-positive. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common gram-negative bacterial and the resistant rates to imipenem were 0.8%, 11.8% and 3.3%, respectively. Detection rates of Extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.0%, respectively. At the same time, Coagulase negative Staphylococcus, Streptococcus and Enterococcus were most common kinds of gram-positive bacteria. Methicillin-resistant coagulase negative staphylococcus accounted for 65.9% antibiotic resistance. No vancomycin and/or linezolid and/or tigecycline resistant strains of Staphylococcus spp. and Enterococcus spp. were found in those patients.

CONCLUSION

Patients with hematology diseases had a higher risk of bacterial infections, mainly caused by Gram-negative bacteria. There are different distributions of bacterial in different wards.

Planning of water resources management and pollution control for Heshui River watershed, China: A full credibility-constrained programming approach

A key issue facing integrated water resources management and water pollution control is to address the vague parametric information. A full credibility-based chance-constrained programming (FCCP) method is thus developed by introducing the new concept of credibility into the modeling framework. FCCP can deal with fuzzy parameters appearing concurrently in the objective and both sides of the constraints of the model, but also provide a credibility level indicating how much confidence one can believe the optimal modeling solutions. The method is applied to Heshui River watershed in the south-central China for demonstration. Results from the case study showed that groundwater would make up for the water shortage in terms of the shrinking surface water and rising water demand, and the optimized total pumpage of groundwater from both alluvial and karst aquifers would exceed 90% of its maximum allowable levels when credibility level is higher than or equal to 0.9. It is also indicated that an increase in credibility level would induce a reduction in cost for surface water acquisition, a rise in cost from groundwater withdrawal, and negligible variation in cost for water pollution control.

Environmental- and health-risk-induced remediation design for benzene-contaminated groundwater under parameter uncertainty: a case study in Western Canada

This study proposes an environmental- and health-risk-induced remediation design approach for benzene-contaminated groundwater. It involves exposure frequency and intake rates that are important but difficult to be exactly quantified as breakthrough point. Flexible health-risk control is considered in the simulation and optimization work. The proposed approach is then applied to a petroleum-contaminated site in western Canada. Different situations about remediation durations, public concerns, and satisfactory degrees are addressed by the approach. The relationship between environmental standards and health-risk limits is analyzed, in association with their effect on remediation costs. Insights of three uncertain factors (i.e. exposure frequency, intake rate and health-risk threshold) for the remediation system are also explored, on a basis of understanding their impacts on health risk as well as their importance order. The case study results show that (1) nature attenuation plays a more important role in long-term remediation scheme than the pump-and-treat system; (2) carcinogenic risks have greater impact on total pumping rates than environmental standards for long-term remediation; (3) intake rates are the second important factor affecting the remediation system's performance, followed by exposure frequency; (4) the 10-year remediation scheme is the most robust choice when environmental and health-risk concerns are not well quantified.

A stochastic optimization model under modeling uncertainty and parameter certainty for groundwater remediation design--part I. Model development

Solving groundwater remediation optimization problems based on proxy simulators can usually yield optimal solutions differing from the "true" ones of the problem. This study presents a new stochastic optimization model under modeling uncertainty and parameter certainty (SOMUM) and the associated solution method for simultaneously addressing modeling uncertainty associated with simulator residuals and optimizing groundwater remediation processes. This is a new attempt different from the previous modeling efforts. The previous ones focused on addressing uncertainty in physical parameters (i.e. soil porosity) while this one aims to deal with uncertainty in mathematical simulator (arising from model residuals). Compared to the existing modeling approaches (i.e. only parameter uncertainty is considered), the model has the advantages of providing mean-variance analysis for contaminant concentrations, mitigating the effects of modeling uncertainties on optimal remediation strategies, offering confidence level of optimal remediation strategies to system designers, and reducing computational cost in optimization processes.

A stochastic optimization model under modeling uncertainty and parameter certainty for groundwater remediation design: part II. Model application

A new stochastic optimization model under modeling uncertainty (SOMUM) and parameter certainty is applied to a practical site located in western Canada. Various groundwater remediation strategies under different significance levels are obtained from the SOMUM model. The impact of modeling uncertainty (proxy-simulator residuals) on optimal remediation strategies is compared to that of parameter uncertainty (arising from physical properties). The results show that the increased remediation cost for mitigating modeling-uncertainty impact would be higher than those from models where the coefficient of variance of input parameters approximates to 40%. This provides new evidence that the modeling uncertainty in proxy-simulator residuals can hardly be ignored; there is thus a need of investigating and mitigating the impact of such uncertainties on groundwater remediation design. This work would be helpful for lowering the risk of system failure due to potential environmental-standard violation when determining optimal groundwater remediation strategies.

A coupled simulation-optimization approach for groundwater remediation design under uncertainty: an application to a petroleum-contaminated site

This study provides a coupled simulation-optimization approach for optimal design of petroleum-contaminated groundwater remediation under uncertainty. Compared to the previous approaches, it has the advantages of: (1) addressing the stochasticity of the modeling parameters in simulating the flow and transport of NAPLs in groundwater, (2) providing a direct and response-rapid bridge between remediation strategies (pumping rates) and remediation performance (contaminant concentrations) through the created proxy models, (3) alleviating the computational cost in searching for optimal solutions, and (4) giving confidence levels for the obtained optimal remediation strategies. The approach is applied to a practical site in Canada for demonstrating its performance. The results show that mitigating the effects of uncertainty on optimal remediation strategies (through enhancing the confidence level) would lead to the rise of remediation cost due to the increase in the total pumping rate.

Flexible interval mixed-integer bi-infinite programming for environmental systems management under uncertainty

A number of inexact programming methods have been developed for municipal solid waste management under uncertainty. However, most of them do not allow the parameters in the objective and constraints of a programming problem to be functional intervals (i.e., the lower and upper bounds of the intervals are functions of impact factors). In this study, a flexible interval mixed-integer bi-infinite programming (FIMIBIP) method is developed in response to the above concern. A case study is also conducted; the solutions are then compared with those obtained from interval mixed-integer bi-infinite programming (IMIBIP) and fuzzy interval mixed-integer programming (FIMIP) methods. It is indicated that the solutions through FIMIBIP can provide decision support for cost-effectively diverting municipal solid waste, and for sizing, timing and siting the facilities' expansion during the entire planning horizon. These schemes are more flexible than those identified through IMIBIP since the tolerance intervals are introduced to measure the level of constraints satisfaction. The FIMIBIP schemes may also be robust since the solutions are "globally-optimal" under all scenarios caused by the fluctuation of gas/energy prices, while the conventional ones are merely "locally-optimal" under a certain scenario.

An inexact dynamic optimization model for municipal solid waste management in association with greenhouse gas emission control

Municipal solid waste (MSW) should be properly disposed in order to help protect environmental quality and human health, as well as to preserve natural resources. During MSW disposal processes, a large amount of greenhouse gas (GHG) is emitted, leading to a significant impact on climate change. In this study, an inexact dynamic optimization model (IDOM) is developed for MSW-management systems under uncertainty. It grounds upon conventional mixed-integer linear programming (MILP) approaches, and integrates GHG components into the modeling framework. Compared with the existing models, IDOM can not only deal with the complex tradeoff between system cost minimization and GHG-emission mitigation, but also provide optimal allocation strategies under various emission-control standards. A case study is then provided for demonstrating applicability of the developed model. The results indicate that desired waste-flow patterns with a minimized system cost and GHG-emission amount can be obtained. Of more importance, the IDOM solution is associated with over 5.5 million tonnes of TEC reduction, which is of significant economic implication for real implementations. Therefore, the proposed model could be regarded as a useful tool for realizing comprehensive MSW management with regard to mitigating climate-change impacts.

Health-risk-based groundwater remediation system optimization through clusterwise linear regression

This study develops a health-risk-based groundwater management (HRGM) model. The model incorporates the considerations of environmental quality and human health risks into a general framework. To solve the model, a proxy-based optimization approach is proposed, where a semiparametric statistical method (i.e., clusterwise linear regression) is used to create a set of rapid-response and easy-to-use proxy modules for capturing the relations between remediation policies and the resulting human health risks. Through replacing the simulation and health risk assessment modules with the proxy ones, many orders of magnitude of computational cost can be saved. The model solutions reveal that (i) a long remediation period corresponds to a low total pumping rate, (ii) a stringent risk standard implies a high total pumping rate, and (iii) the human health risk associated with benzene would be significantly reduced if it is regarded as constraints of the model. These implications would assist decision makers in understanding the effects of remediation duration and human-health risk level on optimal remediation policies and in designing a robust groundwater remediation system. Results from postoptimization simulation show that the carcinogenic risk would decrease to satisfy the regulated risk standard under the given remediation policies.

A simulation-aided factorial analysis approach for characterizing interactive effects of system factors on composting processes

A simulation-aided 2-level factorial analysis approach is proposed to characterize the interactive effects of composting factors (i.e. temperature, moisture, oxygen content and initial biomass concentration) on composting processes. To screen the important effect factors when high-order interactions occur, normal probability plot is applied to the result analysis. The results show that the factors have various effects on the composting process in different stages. At the 24th hour, the factors do not show significant effects on the composting process. At the 72nd hour when the composting process reaches active stage, the factors have important effects on the composting process, and their interactive effects are also significant. At the 144th hour, temperature and oxygen content still have effects on the composting process, but not as significant as those at the active stage. These findings could be useful for guiding composting-process operation and management and developing associated control strategies in different composting stages.

Modeling of substrate degradation and oxygen consumption in waste composting processes

A multi-component modeling system was developed to simulate substrate degradation and oxygen consumption in waste composting processes. Levels of soluble substrate (Ss), insoluble substrate (Si), active biomass (X), inert material, moisture, temperature, and oxygen concentration were considered as state variables. The relationships among these variables were also incorporated within the modeling framework. Three conversion reactions, including growth of aerobic biomass, decay of aerobic biomass, and solubilisation of insoluble substrate, were considered in the simulation system. The modeling inputs included temperature, moisture, oxygen concentration, and initial conditions of the state variables, while the outputs included oxygen uptake accumulation (OUA), oxygen uptake rate (OUR), Ss, Si, and X for representing the substrate degradation and oxygen consumption status. The effectiveness of the developed model was demonstrated through its application to a case study in a 30L vessel over 200h. Through verification-based composting experiments, it was shown that the modeling solutions were consistent with the experimental results with an acceptable accuracy level. Sensitivity analyses of the model showed that an increased maximum microbial growth rate would result in raised OUA, OUR, Ss, and X levels; a decreased biomass decay rate constant would help enhance the composting process. Moreover, variations in the maximum growth rate would affect the composting process more significantly than those of the biomass decay rate constant.

Out-of-plane temperature-dependent resistivity studies on Tl-based superconductors

Temperature-dependent resistivities in the ab-plane and c-axis of Tl-based cuprates have been measured. Unlike the ab-plane properties, which are metallic, c-axis transport is semiconductor-like in the normal state for Tl(2)Ba(2)Ca(2)Cu(3)O(x) (Tl-2223) and Tl(2)Ba(2)CaCu(2)O(x) (Tl-2212). In contrast, for Tl(2)Ba(2)CuO(x) (Tl-2201), transport is metal-like in both the in-plane and the c-axis. For multi-layered cuprates, transport properties along the c-axis could be described by a tunnelling model, whereas for single-layered compound Tl-2201 it would be easier for the out-of-plane transport behaviour to be coherent since the there are no insulating Ca layers in its structure. Moreover, combining the studies on Bi-2201, which has an insulating behaviour for the out-of-plane resistivity, we suggest that the Tl-O layers in Tl-based superconductors could be conducting, unlike the weakly correlated Bi-O layers in Bi-based cuprates.

Effect of three flavonoids, 5,7,3',4'-tetrahydroxy-3-methoxy flavone, luteolin, and quercetin, on the stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophil

The effect of three flavonoids, 5,7,3',4'-tetrahydoxy-3-methoxy flavone (THMF), luteolin, and quercetin, on the stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils were investigated. When the cells were preincubated with these flavonoids, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed, showing a dependence on amounts of the flavonoid. The suppressing effect of the flavonoid was THMF > luteolin > quercetin. These flavonoids also suppressed the superoxide generation induced by phorbol 12-myristate 13-acetate. In this case also, THMF was more effective than luteolin and quercetin. On the other hand, the superoxide generation induced by arachidonic acid was markedly suppressed by quercetin. The suppressing effect was quercetin >> THMF > luteolin. THMF, luteolin, and quercetin significantly suppressed tyrosyl phosphorylation of 80.1-, 58.0-, and 45.0-kDa proteins in fMLP-treated human neutrophils. The suppression depended on the concentration of the flavonoids, and the inhibition of tyrosyl phosphorylation was in parallel to that of the fMLP-induced superoxide generation, respectively. While luteolin and quercetin showed a weak hemolytic activity at 2.5 mM, THMF showed almost no hemolytic activity even at 5 mM, suggesting an advantage of THMF for its clinical use.

Internalization of an intact doxorubicin immunoconjugate

An immunoconjugate between doxorubicin and anti-(carcinoembryonic antigen) (CEA) was prepared by using aminodextran (M(r) = 40,000) as the intermediate carrier, and the carbohydrate moiety of the antibody as the linking site. The resulting immunoconjugate was subjected to an in vitro evaluation for the internalization on the target cells (Lo Vo), and compared to that of unconjugated antibody, as well as the cellular uptake of unconjugated doxorubicin. The internalization was evaluated microscopically by following the translocation of the red fluorescence of doxorubicin and the green fluorescence of the fluorescein-isothiocyanate-labeled goat anti-(mouse Ig) antibody, which visualizes the location of the primary mouse antibody. Anti-CEA monoclonal antibody (NP-4) was found to internalize into Lo Vo cells. The immunoconjugate made with this antibody was similarly internalized, and the doxorubicin was found to distribute with the primary antibody. The cell surface and cytoplasm were the major compartments of their distribution. These results indicate that the drug molecules were indeed delivered into the cells by the antibody as an intact conjugate. Unconjugated doxorubicin, on the contrary, was quickly absorbed by the cells and concentrated in the nucleus within 30 min, and never showed a distribution in the cytoplasm or cell membrane as in the nucleus by this procedure. The intermediate drug conjugate, doxorubicin-dextran, did not show internalization. The internalization of NP-4 antibody (or the doxorubicin conjugate) was also confirmed by studying the intracellular catabolism of the cell-bound antibody (or conjugate). The release of the degraded antibody by the cells, as differentiated by trichloroacetic acid precipitation techniques, was considered an indication of internalization. Lysosomes were involved in the degradation, since the process was markedly inhibited in the presence of the lysosomal enzyme inhibitor, ammonium chloride.

Hormonal effects on the surfactant protein B (SP-B) mRNA in cultured fetal rat lung

Glucocorticoids, triiodothyronine (T3), and cyclic adenosine monophosphate (cAMP) have been shown previously to modulate phosphatidylcholine and surfactant protein A (SP-A) synthesis in fetal rat lung explant cultures. In this report, we have examined the hormonal regulation of the rat surfactant protein B (SP-B) mRNA to determine whether SP-B expression is coordinately regulated with the surfactant phospholipids or with SP-A. Dexamethasone (1 to 200 nM) and cAMP (200 microM) had a stimulatory effect on SP-B mRNA levels, whereas T3 tended to inhibit the accumulation of SP-B mRNA. In combination experiments, treatment with dibutyryl-cAMP (200 microM) and dexamethasone (100 nM) resulted in about a 22-fold increase, whereas dexamethasone or dibutyryl-cAMP alone produced 18- and 2-fold increases, respectively. When the cAMP analogue 8-bromo-cAMP (200 microM) was used in combination with dexamethasone, there was no significant difference between the combined effect and that of dexamethasone alone. T3 treatment, however, resulted in a significant reduction of the dexamethasone-induced stimulation from about a 22-fold to a 14-fold increase. Tissue in situ hybridization showed that dexamethasone stimulated the levels of SP-B mRNA in cells from both the alveolar and bronchiolar epithelium. These data indicate that there are differences in the hormonal regulation of the components of surfactant, suggesting that they are independently regulated.