Predictive Value of Nasal Nitric Oxide for Diagnosing Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis

OBJECTIVES

The primary aim of this study was to assess disparities in nasal nitric oxide (NO) levels between individuals diagnosed with eosinophilic chronic rhinosinusitis (ECRS) and those without ECRS. The second aim was to ascertain the comparative predictive efficacy of these nasal NO levels for the presence of ECRS.

METHODS

A systematic analysis was conducted on relevant studies that compared nasal NO levels in individuals with ECRS and those without. Furthermore, the discriminatory capacity of nasal NO in distinguishing ECRS from non-ECRS cohorts was quantified. The risk of bias across studies was evaluated utilizing the Newcastle-Ottawa scale.

RESULTS

The comprehensive review encompassed a total of 5 studies involving 470 participants. Findings revealed that patients diagnosed with ECRS exhibited significantly higher levels of nasal NO, as measured in parts per billion (ppb), compared to their non-ECRS patients. The mean difference was 130.03 ppb (95% confidence interval: [66.30, 193.75], I2 = 58.7%). The diagnostic odds ratio for nasal NO in identifying ECRS was 9.29 ([5.85, 14.75], I2 = 26.4%). The area under the summary receiver operating characteristic curve was 0.82. The correlation between sensitivity and false positive rate was 0.53, suggesting a lack of heterogeneity. Sensitivity, specificity, negative predictive value, and positive predictive value were 69% ([0.55, 0.79], I2 = 77.0%), 83% ([0.73, 0.90], I2 = 68.5%), 77% ([0.69, 0.83], I2 = 50.1%), and 75% ([0.67, 0.82], I2 = 41.5%), respectively.

CONCLUSION

Nasal NO has the potential as a noninvasive diagnostic measure and endotype tool for ECRS.

Efficient production of (S)-limonene and geraniol in Saccharomyces cerevisiae through the utilization of an Erg20 mutant with enhanced GPP accumulation capability

Monoterpenes and monoterpenoids such as (S)-limonene and geraniol are valuable chemicals with a wide range of applications, including cosmetics, pharmaceuticals, and biofuels. Saccharomyces cerevisiae has proven to be an effective host to produce various terpenes and terpenoids. (S)-limonene and geraniol are produced from geranyl pyrophosphate (GPP) through the enzymatic actions of limonene synthase (LS) and geraniol synthase (GES), respectively. However, a major hurdle in their production arises from the dual functionality of the Erg20, a farnesyl pyrophosphate (FPP) synthase, responsible for generating GPP. Erg20 not only synthesizes GPP by condensing isopentenyl pyrophosphate (IPP) with dimethylallyl pyrophosphate but also catalyzes further condensation of IPP with GPP to produce FPP. In this study, we have tackled this issue by harnessing previously developed Erg20 mutants, Erg20K197G (Erg20G) and Erg20F96W, N127W (Erg20WW), which enhance GPP accumulation. Through a combination of these mutants, we generated a novel Erg20WWG mutant with over four times higher GPP accumulating capability than Erg20WW, as observed through geraniol production levels. The Erg20WWG mutant was fused to the LS from Mentha spicata or the GES from Catharanthus roseus for efficient conversion of GPP to (S)-limonene and geraniol, respectively. Further improvements were achieved by localizing the entire mevalonate pathway and the Erg20WWG-fused enzymes in peroxisomes, while simultaneously downregulating the essential ERG20 gene using the glucose-sensing HXT1 promoter. In the case of (S)-limonene production, additional Erg20WWG-LS was expressed in the cytosol. As a result, the final strains produced 1063 mg/L of (S)-limonene and 1234 mg/L of geraniol by fed-batch biphasic fermentations with ethanol feeding. The newly identified Erg20WWG mutant opens doors for the efficient production of various other GPP-derived chemicals including monoterpene derivatives and cannabinoids.

Perinatal Risk Factors in Relation to Asthma and Allergic Rhinitis in Children and Adolescents

Objectives

To evaluate the associations between birth-related exposures and postnasal factors and risk for allergic rhinitis and asthma in children and adolescents.

Methods

We conducted a comprehensive search of five literature databases up until May 2023. To estimate the associations between birth-related exposures (birth weight, mode of delivery, prematurity, sex, maternal age, and parental history of allergy) and postnatal factors (birth order, number of siblings, exclusive, and duration of breastfeeding) and allergic disease, we calculated pooled odds ratios with 95% confidence intervals. In addition, we performed subgroup analyses according to allergic disease, birth order, number of siblings, and parental history of allergy. Methodological quality of the included studies was assessed using the Newcastle-Ottawa scale.

Results

This meta-analysis included 31 studies with 218,899 patients. Among the birth-related exposures, low birth weight, maternal age, and prematurity (<37 weeks) showed no significant associations with risk for asthma or allergic rhinitis in childhood or adolescence. On the other hand, male sex, family history of allergy, and cesarean section were related to higher risk for asthma or allergic rhinitis. Among postnatal factors, exclusive breastfeeding, long duration (>6 months) of breastfeeding, birth order second or later, and presence of sibling(s) showed preventive effects against allergic disease in offspring.

Conclusion

The risks for allergic rhinitis and asthma were higher in male patients delivered by cesarean section and with a family history of allergy. By contrast, exclusive and long duration (>6 months) breastfeeding and the presence of sibling(s) reduced the risk of developing respiratory allergic disease.

Evaluation of force pain thresholds to ensure collision safety in worker-robot collaborative operations

With the growing demand for robots in the industrial field, robot-related technologies with various functions have been introduced. One notable development is the implementation of robots that operate in collaboration with human workers to share tasks, without the need of any physical barriers such as safety fences. The realization of such collaborative operations in practice necessitates the assurance of safety if humans and robots collide. Thus, it is important to establish criteria for such collision scenarios to ensure robot safety and prevent injuries. Collision safety must be ensured in both pinching (quasi-static contact) and impact (transient contact) situations. To this end, we measured the force pain thresholds associated with impacts and evaluated the biomechanical limitations. This measurements were obtained through clinical trials involving physical collisions between human subjects and a device designed for generating impacts, and the force pain thresholds associated with transient collisions between humans and robots were analyzed. Specifically, the force pain threshold was measured at two different locations on the bodies of 37 adults aged 19-32 years, using two impactors with different shapes. The force pain threshold was compared with the results of other relevant studies. The results can help identify biomechanical limitations in a precise and reliable manner to ensure the safety of robots in collaborative applications.

A comparison of doxycycline and conventional treatments of refractory chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis

PURPOSE

To compare the effects of doxycycline (DOX) and conventional management in patients with refractory chronic rhinosinusitis and nasal polyps (CRSwNP).

METHODS

Six databases were searched to September 2023. We retrieved studies that compared improvements in refractory chronic sinusitis-related symptoms between DOX-treated and control groups.

RESULTS

DOX significantly reduced the Lund-Kennedy (LK) score [- 0.3670 (range - 0.6173; - 0.1166); I2 = 92.8%], the nasal polyposis score [- 0.9484 (- 1.2287; - 0.6680); I2 = 92.5%], the patient-reported Sinonasal Outcome Test (SNOT) score [- 0.3141 (- 0.4622; - 0.1660); I2 = 91.2%], and the nasal obstruction score [- 0.1813 (- 0.3382; - 0.0243); I2 = 86.2%]. On subgroup analyses by the measurement timepoints, the extent of nasal polyposis was significantly lower in the DOX group during treatment, at the end of treatment, and 4 and 8 weeks later. The LK scores also indicated improvements during treatment and at the end of treatment. The SNOT score tended to decrease with time in the treatment group. Nasal obstruction symptoms improved during treatment and 4 weeks later.

CONCLUSION

DOX enhances the postoperative endoscopic outcomes of refractory CRSwNP patients by reducing recurrent polyposis and inflammation.

Detection of novel drug-adverse drug reaction signals in rheumatoid arthritis and ankylosing spondylitis: analysis of Korean real-world biologics registry data

This study aimed to detect signals of adverse drug reactions (ADRs) associated with biological disease-modifying antirheumatic drugs (DMARDs) and targeted therapies in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients. Utilizing the KOrean College of Rheumatology BIOlogics & Targeted Therapy Registry (KOBIO) data, we calculated relative risks, excluded previously reported drug-ADR pairs, and externally validated remaining pairs using US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and single centre's electronic health records (EHR) data. Analyzing data from 2279 RA and 1940 AS patients, we identified 35 significant drug-ADR pairs in RA and 26 in AS, previously unreported in drug labels. Among the novel drug-ADR pairs from KOBIO, 15 were also significant in the FAERS data. Additionally, 2 significant drug-laboratory abnormality pairs were found in RA using CDM MetaLAB analysis. Our findings contribute to the identification of 14 novel drug-ADR signals, expanding our understanding of potential adverse effects related to biological DMARDs and targeted therapies in RA and AS. These results emphasize the importance of ongoing pharmacovigilance for patient safety and optimal therapeutic interventions.

An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

Phase I dose escalation and expansion study of golidocitinib, a highly selective JAK1 inhibitor, in relapsed or refractory peripheral T-cell lymphomas

BACKGROUND

Relapsed or refractory peripheral T-cell lymphomas (r/r PTCLs) are a group of rare and aggressive diseases that lack effective therapies. Constitutive activation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway is reported to be associated with PTCLs. Golidocitinib is an oral, potent JAK1 selective inhibitor evaluated in a phase I/II multinational study in patients with r/r PTCLs.

PATIENTS AND METHODS

Patients with r/r PTCLs were eligible. The primary objectives were to assess safety and tolerability of golidocitinib and to define its recommended phase II dose (RP2D). The secondary objectives were to evaluate its antitumor activity and pharmacokinetics (PK).

RESULTS

A total of 51 patients were enrolled and received golidocitinib treatment at 150 or 250 mg once daily (QD). The median prior lines of therapies were 2 (range: 1-8). Golidocitinib was tolerated at both doses tested, while a higher incidence of serious adverse events and dose modifications at 250 mg were observed. The most common grade ≥3 drug-related treatment-emergent adverse events were neutropenia (27.5%) and thrombocytopenia (11.8%). An objective response rate of 39.2% and a complete response rate of 21.6% were observed. With median follow-up time of 14.7 and 15.9 months, the median duration of response (DoR) and progression-free survival were 8.0 and 3.3 months, respectively. Based on these data, 150 mg QD was defined as the RP2D. Golidocitinib demonstrated a favorable PK profile as an oral agent. Biomarker analysis suggested a potential correlation between JAK/STAT pathway aberrations and clinical activity of golidocitinib.

CONCLUSIONS

In this phase I study, golidocitinib demonstrated an acceptable safety profile and encouraging antitumor efficacy in heavily pretreated patients with r/r PTCLs. These results support the initiation of the multinational pivotal study in patients with r/r PTCLs.

Clashes and crowds: protests, riots, and other mass gathering events in North America 2021-2022

OBJECTIVE

This study aimed to provide an overview of the scope and challenges of historic events and help better prepare emergency healthcare services for future similar mass gathering events.

STUDY DESIGN

This was a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022.

INTRODUCTION

Recent protests, riots, and other conflict events in North America have highlighted the increasing challenges hospital-based and prehospital healthcare providers face. This study provides a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022, which may aid emergency healthcare services in understanding the scope and challenges of historic events and help better prepare for future similar mass gathering events.

METHODS

Data collection was performed using a retrospective database search through the Armed Conflict Location & Event Data Project (ACLED) database. The ACLED database was searched using the internal database search functions for recorded events that occurred in North America from January 1, 2021 to December 31, 2022. Date, event type, event subtype, the country of incident, and fatality numbers were extracted. The results were exported into an Excel spreadsheet and analyzed independently by L.C., H.S., and R.H.

RESULTS

There were a total of 52,529 recorded events of political conflict in North America, with 30,269 events in 2021 and 29,260 in 2022. Political conflict events included protests (40,934, 68.8%), violence against civilians (11,532, 19.4%), strategic developments (2,819, 4.7%), battles (2,293, 3.9%), riots (1,909, 3.2%), and remote violence (42, 0.1%). Violence against civilians caused the highest fatalities (13,466, 82.6%), followed by battles (2,662, 16.3%), riots (111, 0.7%), strategic developments, remote violence, and protests (57, 6, and 3 respectively).

CONCLUSION

Mexico and the United States accounted for most of the political conflicts in North America across 2021 and 2022. In Mexico, protests and violence against civilians were the most common types of conflict, with the latter accounting for the comparatively high fatality compared with the other countries. Battles in Mexico between cartels were the most deadly political conflicts recorded in North America.

17-year trends of body mass index, overweight, and obesity among adolescents from 2005 to 2021, including the COVID-19 pandemic: a Korean national representative study

OBJECTIVE

There is a lack of pediatric studies that have analyzed trends in mean body mass index (BMI) and the prevalence of obesity and overweight over a period that includes the mid-stage of the COVID-19 pandemic. Thus, we aimed to investigate trends in BMI, overweight, and obesity among Korean adolescents from 2005 to 2021, including the COVID-19 pandemic.

SUBJECTS AND METHODS

We used data from the Korea Youth Risk Behavior Web-based Survey (KYRBS), which is nationally representative of South Korea. The study included middle- and high-school students between the ages of 12 and 18. We examined trends in mean BMI and prevalence of obesity and/or overweight during the COVID-19 pandemic and compared these to those of pre-pandemic trends in each subgroup by gender, grade, and residential region.

RESULTS

Data from 1,111,300 adolescents (mean age: 15.04 years) were analyzed. The estimated weighted mean BMI was 20.48 kg/m2 (95% CI, 20.46-20.51) between 2005 and 2007, and this was 21.61 kg/m2 (95% CI, 21.54-21.68) in 2021. The prevalence of overweight and obesity was 13.1% (95% CI, 12.9-13.3%) between 2005 and 2007 and 23.4% (95% CI, 22.8-24.0%) in 2021. The mean BMI and prevalence of obesity and overweight have gradually increased over the past 17 years; however, the extent of change in mean BMI and in the prevalence of obesity and overweight during the pandemic was distinctly less than before. The 17-year trends in the mean BMI, obesity, and overweight exhibited a considerable rise from 2005 to 2021; however, the slope during the COVID-19 pandemic (2020-2021) was significantly less prominent than in the pre-pandemic (2005-2019).

CONCLUSIONS

These findings enable us to comprehend long-term trends in the mean BMI of Korean adolescents and further emphasize the need for practical prevention measures against youth obesity and overweight.

Reference genes for the developing mouse lung under consideration of biological, technical and experimental confounders

For gene expression analysis, the raw data obtained from RT-qPCR are preferably normalized to reference genes, which should be constantly expressed regardless of experimental conditions. Selection of reference genes is particularly challenging for the developing lung because of the complex transcriptional and epigenetic regulation of genes during organ maturation and injury repair. To date, there are only limited experimental data addressing reliable reference genes for this biological circumstance. In this study, we evaluated reference genes for the lung in neonatal C57BL/6 mice under consideration of biological, technical and experimental conditions. For that, we thoroughly selected candidates from commonly used reference genes side-by-side with novel ones by analyzing publicly available microarray datasets. We performed RT-qPCR of the selected candidate genes and analyzed their expression variability using GeNorm and Normfinder. Cell-specific expression of the candidate genes was analyzed using our own single-cell RNA-sequencing data from the developing mouse lung. Depending on the investigated conditions, i.e., developmental stages, sex, RNA quality, experimental condition (hyperoxia) and cell types, distinct candidate genes demonstrated stable expression confirming their eligibility as reliable reference genes. Our results provide valuable information for the selection of proper reference genes in studies investigating the neonatal mouse lung.

Health-related quality of life of inpatients and outpatients with TB in rural Malawi

INTRODUCTION: Patients being treated for TB may suffer reductions in health-related quality of life (HRQoL). This study aims to assess the extent of such reductions and the trajectory of HRQoL over the course of treatment in rural Malawi.METHODS: We collected patient demographic and socioeconomic status, TB-related characteristics, and HRQoL data (i.e., EQ-5D and a visual analogue scale VAS) from adults (age ≥18 years) being treated for TB in 12 primary health centers and one hospital in rural Thyolo District, Malawi, from 2014 to 2016. Associations between HRQoL and patient characteristics were estimated using multivariable linear regression.RESULTS: Inpatients (n = 197) consistently showed lower median HRQoL scores and suffered more severe health impairments during hospitalization than outpatients (n = 156) (EQ5D and VAS: 0.79, 55 vs. 0.84, 70). Longer treatment duration was associated with higher HRQoL among outpatients (EQ5D: 0.034 increase per 2 months, 95%CI 0.012-0.057). We found no substantial associations between patients´ demographic and socioeconomic characteristics and HRQoL in this setting.CONCLUSION: HRQoL scores among patients receiving treatment for TB in rural Malawi differ by clinical setting and duration of treatment, with greater impairment among inpatients and those early in their treatment course.

Occurrences of benzalkonium chloride in streams near a pharmaceutical manufacturing complex in Korea and associated ecological risk

Benzalkonium chloride (BKC) is a commonly used preservative in personal care products and pharmaceutical preparations. However, its ecological risks are not well understood because of lack of monitoring data and ecotoxicological information. In the present study, occurrence of BKC was investigated in the waters near a pharmaceutical manufacturing complex of South Korea and its acute and chronic ecotoxicities were evaluated using Daphnia magna and Japanese medaka (Oryzias latipes). Associated ecological risks were estimated by calculating hazard quotients (HQs). In addition, endocrine disruption potency of BKC was compared with those of other frequently used preservatives using human adrenal (H295R) and rat pituitary (GH3) cells. High concentration of BKC was detected at locations near the pharmaceutical manufacturing plants, i.e., 35.8 μg/L for dodecyl benzyl dimethyl ammonium chloride (BKC-C₁₂), and 21.6 μg/L tetradecyl benzyl dimethyl ammonium chloride (BKC-C₁₄). In Daphnia, 48 h immobilization EC₅₀ and 21 d reproduction NOEC were determined at 41.1 μg/L and ≥10.8 μg/L, respectively. For O. latipes, 96 h LC₅₀ was determined at 246 μg/L while the growth inhibition NOEC was ≥113.4 μg/L following early life stage exposure. BKC significantly up-regulated vitellogenin gene of juvenile fish, indicating its endocrine disrupting potential in fish. Exposure to BKC increased steroid hormone level in H295R cells, and induced cytotoxicity in GH3 cells. HQ values of BKC were determined at greater than one in the ambient water near pharmaceutical manufacturing facilities. Considering high ecological risk and endocrine disrupting potential, long-term consequences of BKC contamination in aquatic ecosystem need to be examined.

How Do Caregivers of Children with Congenital Heart Disease Navigate the Health Care System in Ethiopia?

Research Objective

Global surgery is becoming an increasingly important global health agenda. Cardiovascular disease is the major cause of mortality around the world, and congenital heart disease is the leading cause of morbidity in children. This study aimed to investigate and illustrate the caregivers’ experiences of accessing the health care system and undergoing pediatric cardiac surgery for children with congenital heart disease (CHD).

Study Design

A qualitative study was conducted. Interviews were conducted in December 2019 in Amharic, then translated into English using trained local interpreters. Data were transcribed verbatim and analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework, using NVivo. The candidacy framework explores the access to health care utilization by seven elements: candidacy, navigation, the permeability of services, appearances at health services, adjudications, offers and resistance, and operating conditions and the local production of candidacy.

Population Studied

Interviews were conducted with 13 caregivers of 10 patients with congenital heart disease that received cardiac surgery during the week of the interview.

Principal Findings

The following three themes emerged from the interviews: (a) Recognition of CHD mostly took place at birth, but for those born at home, they found out much later (max 14 years); (b) CHD was misdiagnosed multiple times prior to seeking care at a large hospital; and (c) patients were waiting for the surgery for more than a year, (d) being scheduled for surgery induced both anxiety and hopefulness. In the discussion, caregivers had financial difficulties and struggled in a fragmented delivery system and experienced poor service quality such as the inaccuracy of diagnosis while navigating the Ethiopian health care system.

Conclusions

Major care‐seeking delays were related to the inefficient and complex health care system, largely due to lack of early CHD recognition and financial hardships. Financial protection is low despite the availability of fee waivers for medications. Low education attainment and distance to hospitals are contributing to this challenge.

Implications for Policy or Practice

Overall, Ethiopia needs to prioritize policies that protect the financial status of low‐income households that need health care services. Along with increasing health care workforce capacity for pediatric cardiac surgeries in Ethiopia, there is a need to strengthen the district‐level screening capacity to facilitate earlier diagnosis at easily accessible health care settings.

Primary Funding Source

Search Results Web results Korea International Cooperation Agency.

AB0095 PRECLINICAL CHARACTERIZATION OF CJ-15314, A HIGHLY SELECTIVE JAK1 INHIBITOR, FOR THE TREATMENT OF AUTOIMMUNE DISEASES

Background:

Janus kinases (JAK1, JAK2, JAK3, and TYK2) play critical roles in mediating various cytokine signaling, and has been developed as a target for autoimmune diseases such as RA. Tofacitinib, oral Pan-JAK inhibitor, demonstrated efficacy in RA patients, but its widespread use is limited by safety issues. Baricitinib, JAK1/2 inhibitor, is also known to interfere with the hematopoiesis system, such as anemia and thrombocytopenia associated with suppression of JAK2 signals. Therefore, it is necessary to develop a new potent compound that selectively inhibits JAK1 over JAK2, 3

Objectives:

To identify the pharmacological characteristic based on efficacy of CJ-15314 as potent and selective JAK1 inhibitor for treatment of autoimmune disease.

Methods:

In vitro, cell-based, kinase panel, Kd value and human whole blood assay were performed to determine the inhibition potency and selectivity for JAK subfamily kinases. In vivo therapeutic potential was evaluated by RA model including rat Adjuvant-Induced Arthritis (AIA) and collagen-induced arthritic (CIA). To confirm the possibility of further expansion into the autoimmune disease, BioMAP® Diversity PLUS® Panel was performed by discoverX.

Results:

In vitro assay, CJ-15314 inhibited JAK kinase family in a concentration-dependent manner with IC50 values of 3.8 nM against JAK1, Selectivity for JAK1 over JAK2, 3 was approximately 18, 83 fold greater for CJ-15314. In 1mM ATP condition, CJ-15314 has been confirmed to have the highest JAK1 selectivity over competing drugs, under 1 mM ATP condition that reflects the physiological environment in the body. Similarly, Kd values has also confirmed the selectivity of JAK1, which is 10 fold higher than JAK2, 3. Accordingly, in human whole blood assays, CJ-15314 is 11 fold more potent against IL-6 induced pSTAT1 inhibition through JAK1 (IC50 value: 70 nM) than GM-CSF-induced pSTAT5 inhibition (JAK2) whereas baricitinib and filgotinib exhibited only 2 fold and 7 fold respectively.

In vivo efficacy model, CJ-15314 inhibited disease severity scores in a dose dependent manner. In the rat AIA model, CJ-15314 at 30 mg/kg dose showed 95.3% decrease in arthritis activity score, 51.2% in figotinib at 30 mg/kg, 97.7% showed baricitinib at 10 mg/kg. CJ-15314 showed superior anti-arthritic efficacy than filgotinib. CJ-15314 also minimally affected anemia-related parameters but not bricitinib end of the 2-week treatment. In the rat CIA model, like 10 mg/kg of bricitinib, 30 mg/kg of CJ-15314 also has a similar effect, with a significant reduction in histopathological scores.

In biomap diversity panel, CJ-15314 inhibited the expression of genes such as MCP-1, VCAM-1, IP-10, IL-8, IL-1, sTNF-α and HLA-DR confirming the possibility of expansion into other diseases beyond arthritis.

Conclusion:

CJ-15314 is a highly selective JAK1 inhibitor, demonstrates robust efficacy in RA animal model and is good candidate for further development for inflammatory diseases.

* CJ-15314 is currently conducting a phase I trial in south Korea.

References:

[1]Clark JD et al. Discovery and development of Janus kinase (JAK) inhibitors for inflammatory diseases. J Med Chem. 2014; 57(12):5023-38.

[2]Burmester GR et al. Emerging cell and cytokine targets in rheumatoid arthritis. Nat Rev Rheumatol. 2014; 10(2):77-88

[3]Jean-Baptiste Telliez et al. Discovery of a JAK3-selective inhibitor: functional differentiation of JAK3-selective inhibition over pan-JAK or JAK1-selective inhibition. ACS Chem. Biol., 2016; 11 (12):3442-3451

Disclosure of Interests:

so young Ki Employee of: CJ healthcare, hyunwoo shin Employee of: CJ healthcare, yelim lee Employee of: CJ healthcare, Hyoung rok Bak Employee of: CJ healthcare, hana yu Employee of: CJ healthcare, Seung Chan Kim Employee of: CJ healthcare, juhyun lee Employee of: CJ healthcare, donghyun kim Employee of: CJ healthcare, Dong-hyun Ko Employee of: CJ Healthcare, dongkyu kim Employee of: CJ healthcare

0775 Effects of Stress, Sleep and Depression on Resilience of Female Nurses Working in Shift and Fixed Work Schedules in General Hospital

Introduction

Healthy sleep is important and can have a positive effect on resilience. The aim of the present study was to compare the differences in resilience between two group nurses in rotating shift and daytime fixed work schedules and to investigate stress perception, coping factors, social and psychological health, and sleep factors that may affect resilience.

Methods

A total of 400 female nurses having rotating shift and daytime fixed work schedules at two hospital were surveyed from June 12, 2017 to June 12, 2018. Perceived stress scale(PSS), stress coping short form(Brief COPE), psycho-social wellbeing Index short form(PWI-SF) or general health questionnaire-18(GHQ-18), center for epidemiologic studies depression scale(CES-D), STAI-X-1 in state-trait anxiety inventory(STAI), Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), insomnia severity index(ISI), Conner Davidson resilience scale(CD-RISC) applied. Independent t-test, paired t-test, Pearson correlation analysis, and multiple regression analysis were applied to the results of the final 373 questionnaires of 400 nurses in two general hospitals.

Results

As a result of comparing the variable statistics between the two groups of rotating shift and daytime fixed work nurses, there were statistically significant differences in all variables except perceived stress, sleep quality, and daytime sleepiness. Factors that had a significant correlation with resilience were stress coping strategies, depression, and insomnia severity(p&lt;0.001). In multiple regression analysis, the larger positive reframing1(β=0.206, p&lt;0.001), the less depression (β= -3.45, p&lt;0.001), and the higher psychosocial health level(β=0.193, p &lt;0.001). As acceptance coping2 increases(β=0.129, p&lt;0.05), as daytime sleepiness decreases(β=-1.17, p&lt;0.05), and as active coping2 increases(β=0.118, p&lt;0.05), as the positive reframing2 increases(β=0.110, p&lt;0.05), the resilience increased.

Conclusion

In this study, it was found that resilience was higher in daytime fixed workers than in shift workers. In addition, specific stress coping strategies and sleep, depression, and anxiety factors were found to be associated with resilience.

Support

Key words: Shift work · Female nurse · Resilience · Sleep · Stress · Depression

PIN1 Attenuation Improves Midface Hypoplasia in a Mouse Model of Apert Syndrome

Premature fusion of the cranial suture and midface hypoplasia are common features of syndromic craniosynostosis caused by mutations in the FGFR2 gene. The only treatment for this condition involves a series of risky surgical procedures designed to correct defects in the craniofacial bones, which must be performed until brain growth has been completed. Several pharmacologic interventions directed at FGFR2 downstream signaling have been tested as potential treatments for premature coronal suture fusion in a mouse model of Apert syndrome. However, there are no published studies that have targeted for the pharmacologic treatment of midface hypoplasia. We used Fgfr2^S252W/+ knock-in mice as a model of Apert syndrome and morphometric analyses to identify causal hypoplastic sites in the midface region. Three-dimensional geometric and linear analyses of Fgfr2^S252W/+ mice at postnatal day 0 demonstrated distinct morphologic variance. The premature fusion of anterior facial bones, such as the maxilla, nasal, and frontal bones, rather than the cranium or cranial base, is the main contributing factor toward the anterior-posterior skull length shortening. The cranial base of the mouse model had a noticeable downward slant around the intersphenoid synchondrosis, which is related to distortion of the airway. Within a skull, the facial shape variance was highly correlated with the cranial base angle change along Fgfr2 S252W mutation-induced craniofacial anomalies. The inhibition of an FGFR2 downstream signaling enzyme, PIN1, via genetic knockdown or use of a PIN1 inhibitor, juglone, attenuated the aforementioned deformities in a mouse model of Apert syndrome. Overall, these results indicate that FGFR2 signaling is a key contributor toward abnormal anterior-posterior dimensional growth in the midface region. Our study suggests a novel therapeutic option for the prevention of craniofacial malformations induced by mutations in the FGFR2 gene.

Dynamic predictive model for postoperative nausea and vomiting for intravenous fentanyl patient-controlled analgesia

Postoperative nausea and vomiting is the most common side-effect of opioid-based intravenous patient-controlled analgesia. Apfel's simplified risk score is popular but it has some limitations. We developed and validated a dynamic predictive model for nausea or vomiting up to 48 postoperative hours, available as an online web application. Fentanyl was used by 22,144 adult patients for analgesia after non-cardiac surgery under general anaesthesia: we randomly divided them into development (80%) and validation (20%) cohorts, repeated 100 times. We used linear discriminant analysis to select variables for multivariate logistic regression. The incidences of postoperative nausea or vomiting were: 0-48 h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%); 12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h, 1082/22,144 (5%). The median (95%CI) area under the receiver operating characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were: 0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72); and 0.69 (0.66-0.71), respectively. Our web application allows clinicians to calculate incidences of nausea and vomiting in patients receiving intravenous fentanyl for patient-controlled analgesia.

Comparison of thyroid hormone disruption potentials by bisphenols A, S, F, and Z in embryo-larval zebrafish

Several structural analogues of bisphenol A (BPA), e.g., bisphenol F (BPF), bisphenol S (BPS), and bisphenol Z (BPZ), have been used as its substitutes in many applications and consequently detected in the environment, and human specimen such as urine and serum. While BPA has been frequently reported for thyroid hormone disruption in both experimental and epidemiological studies, less is known for the BPA analogues. In the present study, thyroid hormone disrupting effects of BPF, BPS and BPZ, were investigated, and compared with those of BPA, using embryo-larval zebrafish (Danio rerio). At 120 hpf, significant increases in T3 and/or T4 were observed in the larval fish following exposure to BPA, BPF, or BPS. Moreover, transcriptional changes of the genes related to thyroid development (hhex and tg), thyroid hormone transport (ttr) and metabolism (ugt1ab) were observed as well. Thyroid hormone (T4) disruption by BPF was observed even at the concentration (2.0 mg/L) lower than the effective concentration determined for BPA (>2.0 mg/L). Delayed hatching was observed by all tested bisphenols. Our results clearly show that these BPA analogues can disrupt thyroid function of the larval fish, and their thyroid hormone disruption potencies could be even greater than that of BPA. The concentrations which disrupt thyroid function of the larval fish were orders of magnitude higher than those occurring in the ambient environment. However, thyroid hormone disruption by longer term exposure and its consequences in the fish population, deserve further investigation.

The Detection of UHECRs with the EUSO-TA Telescope

EUSO-TA is a cosmic ray detector developed by the JEM-EUSO (Joint Experiment Missions for Extreme Universe Space Observatory) Collaboration, observing during nighttime the fluorescence light emitted along the path of extensive air showers in the atmosphere. It is installed at the Telescope Array site in Utah, USA, in front of the fluorescence detector station at Black Rock Mesa. It serves as a ground-based pathfinder experiment for future space-based missions. EUSO-TA has an optical system with two Fresnel lenses and a focal surface with 6 × 6 multi-anode photomultiplier tubes with 64 channels each, for a total of 2304 channels. The overall field of view is ∼10.6°× 10.6°. This detector technology allows the detection of cosmic ray events with high spatial resolution, having each channel a field of view of about ∼0.2° × 0.2° and a temporal resolution of 2.5 µs. First observations of ultra-high energy cosmic rays revealed the cosmic ray detection capability of EUSO-TA. The foreseen upgrade of EUSO-TA will improve the efficiency of the detector and will increase the statistics of detected events. In this work we present recent results of the detection capability of EUSO-TA and its limits. Moreover, other results about the analysis of laser pulses, stars and meteors will be discussed.

Development of a new analgesic index using nasal photoplethysmography

Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index^® (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control. Various dynamic photoplethysmography variables were extracted to quantify pain intensity; the most accurate index was selected using logistic regression as a classifier. The area under the curve of the receiver-operating characteristic curve was measured to evaluate the accuracy of final model predictions. In total, 12,012 heart beats from 89 patients were used to develop a new Nasal Photoplethysmography Index for analgesic depth quantification. The two-variable model (a combination of diastolic peak point variation and heart beat interval variation) was most accurate in discriminating between the presence and absence of pain (numerical rating scale (NRS) ≥ 3). The accuracy and area under the curve of the receiver-operating characteristic curve for the Nasal Photoplethysmography Index were 75.3% and 0.8018, respectively, and 64.8% and 0.7034, respectively, for the Surgical Pleth Index. The Nasal Photoplethysmography Index clearly distinguished pain (NRS ≥ 3) in awake surgical patients with postoperative pain. The Nasal Photoplethysmography Index performed better than the Surgical Pleth Index. Further validation studies are needed to evaluate its feasibility to quantify pain intensity during general anaesthesia.

Utilization of biopsy-based genomic classifier to predict distant metastasis after definitive radiation and short-course ADT for intermediate and high-risk prostate cancer

BACKGROUND

We examined the ability of a biopsy-based 22-marker genomic classifier (GC) to predict for distant metastases after radiation and a median of 6 months of androgen deprivation therapy (ADT).

METHODS

We studied 100 patients with intermediate-risk (55%) and high-risk (45%) prostate cancer who received definitive radiation plus a median of 6 months of ADT (range 3-39 months) from 2001-2013 at a single center and had available biopsy tissue. Six to ten 4 micron sections of the needle biopsy core with the highest Gleason score and percentage of tumor involvement were macrodissected for RNA extraction. GC scores (range, 0.04-0.92) were determined. The primary end point of the study was time to distant metastasis. Median follow-up was 5.1 years. There were 18 metastases during the study period.

RESULTS

On univariable analysis (UVA), each 0.1 unit increase in GC score was significantly associated with time to distant metastasis (hazard ratio: 1.40 (1.10-1.84), P=0.006) and remained significant after adjusting for clinical variables on multivariable analysis (MVA) (adjusted hazard ratio: 1.36 (1.04-1.83), P=0.024). The c-index for 5-year distant metastasis was 0.45 (95% confidence interval: 0.27-0.64) for Cancer of the Prostate Risk Assessment score, 0.63 (0.40-0.78) for National Comprehensive Cancer Network (NCCN) risk groups, and 0.76 (0.57-0.89) for the GC score. Using pre-specified GC risk categories, the cumulative incidence of metastasis for GC>0.6 reached 20% at 5 years after radiation (P=0.02).

CONCLUSIONS

We believe this is the first demonstration of the ability of the biopsy-based GC score to predict for distant metastases after definitive radiation and ADT for intermediate- and high-risk prostate cancer. Patients with the highest GC risk (GC>0.6) had high rates of metastasis despite multi-modal therapy suggesting that they could potentially be candidates for treatment intensification and/or enrollment in clinical trials of novel therapy.

RNA in Salivary Extracellular Vesicles as a Possible Tool for Systemic Disease Diagnosis

Saliva contains biological information as blood and is recognized as a valuable diagnostic medium for their noninvasiveness. Although "-omics" researches have tried to investigate saliva, the origin and significance of its contents are not clear, and its usage is largely confined to oral disease in the diagnostic and prognostic field. In an attempt to broaden the applicability of saliva and to find systemic disease-derived RNA in saliva, we made mouse models that had human melanoma and isolated extracellular vesicles (EVs) from their saliva by an aqueous 2-phase system (ATPS), then identified and evaluated their expression of human melan-A RNA, which is associated with melanoma on skin. With ATPS, EVs were isolated efficiently and stably while taking less time compared to isolation by ultracentrifugation. When ATPS was used to isolate EVs from saliva, the mean ± SD percentage of EVs recovered from initial EVs was 38.22% ± 18.55% by the number of particles, and the mean ± SD percentage of RNA recovered from the initial amount was 60.33% ± 5.34%. RNAs within isolated EVs were analyzed subsequently by reverse transcription quantitative polymerase chain reaction and polymerase chain reaction from saliva and plasma. In melanoma mice, amplification of human melan-A was identified from saliva and plasma, even though a relative amount of normalized melan-A was lower than that of plasma. These results present a possibility that RNAs derived from systemic disease are transferred into saliva from blood in EVs. Also, they suggest that saliva could be exploited in obtaining information about systemic disease, not only about oral disease, by examining RNAs in EVs from saliva instead of blood.

Photoplethysmography sampling frequency: pilot assessment of how low can we go to analyze pulse rate variability with reliability?

Pulse rate variability (PRV) analysis appears as the first alternative to heart rate variability analysis for wearable devices; however, there is a constraint on computational load and energy consumption for the limited system resources available to the devices. Considering that adjustment of the sampling frequency is one of the strategies for reducing computational load and power consumption, this study aimed to investigate the influence of sampling frequency (f _s) on PRV analysis and to find the minimum sampling frequency while maintaining reliability. We generated 5000, 2500, 1000, 500, 250, 100, 50, 25, 20, 15, 10, 5 Hz down-sampled photoplethysmograms from 10 kHz-sampled PPGs and derived time- and frequency-domain variables of the PRV. These included AVNN, SDNN, SDSD, RMSSD, NN50, pNN50, total power, VLF, LF, HF, LF/HF, nLF and nHF for each down-sampled signal. Derived variables were compared with heart rate variability of the 10 kHz-sampled electrocardiograms, and then statistically investigated using one-way ANOVA test and Bland-Altman analysis. As a result, significant differences (P  <  0.05) were found for SDNN, SDSD, RMSSD, NN50, pNN50, TP, HF, LF/HF, nLF and nHF, but not for AVNN, VLF and LF. Based on the post hoc tests, it was found that the NN50 and pNN50, SDSD and RMSSD, LF/HF and nHF, SDNN, TP and nLF analysis had significant differences at f _s  ⩽  20 Hz, f _s  ⩽  15 Hz, f _s  ⩽10 Hz; f _s  =  5 Hz, respectively. In other words, a significant difference was not seen for any variable if the f _s was greater than 25 Hz. Consequently, our pilot study suggests that analysis of variability in the time and frequency domain from pulse rate obtained through PPG may be potentially as reliable as that derived from the analysis of the electrocardiogram, provided that f _s  ⩾25 Hz sampling frequency is used.

Searching for novel modes of toxic actions of oil spill using E. coli live cell array reporter system - A Hebei Spirit oil spill study

Oil is a complex mixture of numerous compounds. Therefore, oil spills near shore can cause various adverse effects on coastal ecosystems. However, most toxicological assessments conducted on oil spill sites have focused on limited modes of toxic actions. In the present study, we utilized the Escherichia coli (E. coli) live cell array system (LCA) to identify novel modes of toxicities of the oil spill-affected sediments. For this purpose, sediment samples were collected from an area heavily polluted by Hebei Spirit oil spill (HSOS) incident of 2007. A total of 93 E. coli reporter genes were used to study responses to the chemicals in the mixture. E. coli K12 strains were exposed to extracts of oil or the sediment, and changes in gene expression were measured. Exposure to extracts of crude and weathered oil resulted in decreased expression in ∼30% of tested genes. However, changes in expression observed after exposure to sediment extracts varied. Sediment extracts containing large concentrations of polycyclic aromatic hydrocarbons (PAH) caused down-regulation of >70% of the genes, while extracts containing lesser total concentrations of PAHs exhibited different trends: genes involved in drug resistance were generally up-regulated, while genes responsive to DNA damage were up-regulated in only two extracts. Results suggest that oil pollution can modulate several toxic response pathways related to DNA repair and antibiotic responses. Results from LCA obtained from the sediment and oil samples were different from those observed in the H4IIE-luc assay. Toxicological implications of such observations deserve further examination. Overall, LCA is a promising tool for screening samples and identifying potential modes of toxicities of environmental samples associated with oil spills.