Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Low-dose anti-thymocyte globulin plus low-dose post-transplant cyclophosphamide-based regimen for prevention of graft-versus-host disease after haploidentical peripheral blood stem cell transplants: a large sample, long-term follow-up retrospective study

Introduction

The novel low-dose anti-thymocyte (ATG, 5 mg/kg) plus low-dose post-transplant cyclophosphamide (PTCy, 50 mg/kg) (low-dose ATG/PTCy)-based regimen had promising activity for prevention of graft-versus-host disease (GVHD) in haploidentical-peripheral blood stem cell transplantation (haplo-PBSCT), but its impacts on long-term outcomes remain to be defined.

Methods

We performed a large sample, long-term follow-up retrospective study to evaluate its efficacy for GVHD prophylaxis.

Results

The study enrolled 260 patients, including 162 with myeloid malignancies and 98 with lymphoid malignancies. The median follow-up time was 27.0 months. For the entire cohort, the cumulative incidences (CIs) of grade II-IV and III-IV acute GVHD (aGVHD) by 180 days were 13.46% (95% CI, 9.64%-17.92%) and 5.77% (95% CI, 3.37%-9.07%); while total and moderate/severe chronic GVHD (cGVHD) by 2 years were 30.97% (95% CI, 25.43%-36.66%) and 18.08% (95% CI, 13.68%-22.98%), respectively. The 2-year overall survival (OS), relapse-free survival (RFS), GVHD-free, relapse-free survival (GRFS), non-relapse mortality (NRM), and CIs of relapse were 60.7% (95% CI, 54.8%-67.10%), 58.1% (95% CI, 52.2%-64.5%), 50.6% (95% CI, 44.8-57.1%), 23.04% (95% CI, 18.06%-28.40%), and 18.09% (95% CI, 14.33%-23.97%, respectively. The 1-year CIs of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation were 43.46% (95% CI, 37.39%-49.37%) and 18.08% (95% CI, 13.68%-22.98%), respectively. In multivariate analysis, the disease status at transplantation was associated with inferior survivor outcomes for all patients and myeloid and lymphoid malignancies, while cGVHD had superior outcomes for all patients and myeloid malignancies, but not for lymphoid malignancies.

Discussion

The results demonstrated that the novel regimen could effectively prevent the occurrence of aGVHD in haplo-PBSCT.

Metagenomic Next-Generation Sequencing for Pathogens in Bronchoalveolar Lavage Fluid Improves the Survival of Patients with Pulmonary Complications After Allogeneic Hematopoietic Stem Cell Transplantation

INTRODUCTION

Unbiased metagenomic next-generation sequencing (mNGS) has been used for infection diagnosis. In this study, we explored the clinical diagnosis value of mNGS for pulmonary complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS

From August 2019 to June 2021, a prospective study was performed to comparatively analyze the pathogenic results of mNGS and conventional tests for bronchoalveolar lavage fluid (BALF) from 134 cases involving 101 patients with pulmonary complications after allo-HSCT.

RESULTS

More pathogens were identified by mNGS than with conventional tests (226 vs 120). For bacteria, the diagnostic sensitivity (P = 0.144) and specificity (P = 0.687) were similar between the two methods. For fungus except Pneumocystis jirovecii (PJ), conventional tests had a significantly higher sensitivity (P = 0.013) with a similarly high specificity (P = 0.109). The sensitivities for bacteria and fungi could be increased with the combination of the two methods. As for PJ, both the sensitivity (100%) and specificity (99.12%) of mNGS were very high. For viruses, the sensitivity of mNGS was significantly higher (P = 0.021) and the negative predictive value (NPV) was 95.74% (84.27-99.26%). Pulmonary infection complications accounted for 90.30% and bacterium was the most common pathogen whether in single infection (63.43%) or mixed infection (81.08%). The 6-month overall survival (OS) of 88.89% in the early group (mNGS ≤ 7 days) was significantly higher than that of 65.52% (HR 0.287, 95% CI 0.101-0.819, P = 0.006) in the late group (mNGS > 7 days).

CONCLUSIONS

mNGS for BALF could facilitate accurate and fast diagnosis for pulmonary complications. Early mNGS could improve the prognosis of patients with pulmonary complications after allo-HSCT.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT04051372.

[Analysis on survival time and influencing factors among reported HIV/AIDS in Yunnan Province, 1989-2021]

Objective: To analyze the survival time of reported HIV/AIDS and influencing factors of Yunnan Province from 1989 to 2021. Methods: The data were extracted from the Chinese HIV/AIDS comprehensive response information management system. The retrospective cohort study was conducted. The life table method was applied to calculate the survival probability. Kaplan-Meier was used to draw survival curves in different situations. Furthermore, the Cox proportion hazard regression model was constructed to identify the factors related to survival time. Results: Of the 174 510 HIV/AIDS, the all-cause mortality density was 4.23 per 100 person-years, the median survival time was 20.00 (95%CI:19.52-20.48) years, and the cumulative survival rates in 1, 10, 20, and 30 years were 90.75%, 67.50%, 47.93% and 30.85%. Multivariate Cox proportional risk regression model results showed that the risk of death among 0-14 and 15-49 years old groups were 0.44 (95%CI: 0.34-0.56) times and 0.51 (95%CI:0.50-0.52) times of ≥50 years old groups. The risk for death among the first CD4⁺T lymphocytes counts (CD4) counts levels of 200-349 cells/μl, 350-500 cells/μl and ≥501 cells/μl groups were 0.52 (95%CI: 0.50-0.53) times, 0.41 (95%CI: 0.40-0.42) times and 0.35 (95%CI: 0.34-0.36) times of 0-199 cells/μl groups. The risk of death among the cases that have not received antiretroviral therapy (ART) was 11.56 (95%CI: 11.26-11.87) times. The risk for death among the cases losing to ART, stopping to ART, both losing and stopping ART was 1.66 (95%CI:1.61-1.72) times, 2.49 (95%CI:2.39-2.60) times, and 1.65 (95%CI:1.53-1.78) times of the cases on ART. Conclusions: The influencing factors for the survival time of HIV/AIDS cases were age at diagnosis in Yunnan province from 1989 to 2021. The first CD4 counts levels, antiretroviral therapy, and ART compliance. Early diagnosis, early antiretroviral therapy, and increasing ART compliance could extend the survival time of HIV/AIDS cases.

Impact of Lymphocyte Subsets of Grafts on the Outcome of Haploidentical Peripheral Blood Stem Cell Transplantation

The contribution of lymphocyte subset composition of the graft on the outcomes following haploidentical peripheral blood stem cell transplantation (haploPBSCT) is not fully elucidated. We retrospectively analyzed 314 patients with hematological malignancies who underwent haploPBSCT from 2016 to 2020 in our center. We obtained a cutoff value of CD3+ T cell dose (2.96 × 10⁸/kg) that separated the risk of II-IV acute graft-versus-host disease (aGvHD) and divided patients into the low CD3+ T cell dose group (CD3+ low) and the high CD3+ T cell dose (CD3+ high) group. Significantly higher incidences of I-IV aGvHD, II-IV aGvHD, and III-IV aGvHD were identified in the CD3+ high group (50.8%, 19.8%, and 8.1% in the high group, 23.1%, 6.0%, and 0.9% in the low group, P < 0.0001, P = 0.002, and P = 0.02, respectively). We found that CD4+ T cell and its naïve and memory subpopulations of grafts had a significant impact on aGvHD (P = 0.005, P = 0.018, and P = 0.044). Besides, we found an inferior reconstitution of natural killer (NK) cells in the CD3+ high group than in the low group within the first-year posttransplant (239 cells/μL vs 338 cells/μL, P = 0.0003). No differences in engraftment, chronic GvHD (cGvHD), relapse rate, transplant-related mortality (TRM), and overall survival (OS) were identified between the two groups. In conclusion, our study found that a high CD3+ T cell dose led to a high risk of aGvHD and inferior reconstitution of NK cells in the haploPBSCT setting. In the future, carefully manipulating the composition of lymphocyte subsets of grafts might reduce the risk of aGvHD and improve the transplant outcome.

Immune reconstitution and survival of patients after allogeneic hematopoietic stem cell transplantation from older donors

BACKGROUND

The impact of donor age on the immune reconstitution of patients with hematological malignancies who underwent hematopoietic cell transplantation (HCT) is unclear.

METHOD

We retrospectively compared the outcomes of 381 patients who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) from 308 donors under 50 years of age and 73 donors over 50 years of age. IVIG was regularly supplemented for patients in the first 3 months post-HCT.

RESULTS

The counts of CD8+CD45RA+ naïve T cells were significantly lower in patients of the older donor group than in the younger donor group in the first year after PBSCT (190.6 cells/μl vs. 239.6 cells/μl, p = .018). Patients in the older donor group had significantly fewer CD19+ B cells on day +270 (123.4 cells/μl vs. 183.5 cells/μl, p = .021) and day +365 (169 cells/μl vs. 271.1 cells/μl, p = .01) after PBSCT. Serum IgA (.76 g/L vs. .97 g/L, p < .001) and IgM levels (.75 g/L vs. 1.04 g/L, p < .001) were significantly lower in patients in the older donor group from day +60 to +365 after PBSCT. The EBV reactivation rate within the first 3 months after PBSCT was significantly higher in patients in the older donor group (48.6% vs. 38.3%, p = .034). However, the incidences of CMV reactivation, II-IV acute graft-versus-host disease (aGvHD), chronic GvHD (cGvHD), 3-year relapse rate, 3-year transplant-related mortality (TRM) and 3-year overall survival (OS) were not significantly different between the two groups.

CONCLUSION

In conclusion, donors ≥50 years old were associated with inferior immune reconstitution and higher EBV reactivation in patients after PBSCT, but no change in OS.

Low-Dose Anti-Thymocyte Globulin Plus Low-Dose Posttransplant Cyclophosphamide as an Effective Regimen for Prophylaxis of Graft Versus Host Disease After Haploidentical Peripheral Blood Stem Cell Transplantation With Maternal/Collateral Related Donors

Maternal and collateral donors were associated with a higher incidence of graft-versus-host disease (GvHD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT). A more effective regimen for GvHD prophylaxis after haplo-HSCT with maternal/collateral donors needed to be explored. A retrospective study was performed on 62 patients after haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with maternal/collateral donors, which included 35 patients with low-dose antithymocyte globulin (ATG) plus low-dose posttransplant cyclophosphamide-based (low-dose ATG/PTCy-based) and 27 with ATG-based regimens for GvHD prophylaxis. The 180-day cumulative incidences (CIs) of grades II-IV and III-IV acute GvHD (aGvHD) were 17.7% and 6.8% in low-dose ATG/PTCy-based group, which were significantly lower than that in ATG-based group (55.4% and 31.9%) (P = 0.003 for grade II-IV and P = 0.007 for III-IV aGvHD). In low-dose ATG/PTCy-based group, the 1-year overall survival (OS) and relapse-free survival (RFS) were 80.0%and 80.4%, which were higher than that in ATG-based group with OS of 59.4% and RFS of 62.0%. In multivariate analysis, the low-dose ATG/PTCy-based regimen significantly reduced the risk of grade II-IV (HR = 0.357; P = 0.049) and grade III-IV aGvHD (HR = 0.190; P = 0.046) as an independent risk factor. The results suggested that the low-dose ATG/PTCy-based regimen could effectively prevent the occurrence of aGvHD after haplo-PBSCT with maternal/collateral donors compared with the ATG-based regimen.

POS0370 COMPARATIVE RETINOPATHY RISK OF HIGH- VS LOW-DOSE HYDROXYCHLOROQUINE AMONG 4,677 INCIDENT LONG-TERM USERS: EMULATED TARGET TRIAL ANALYSES

Background

Hydroxychloroquine (HCQ) is a key treatment for patients with lupus, but the major long-term toxicity is HCQ retinopathy. A large cross-sectional study found a prevalence of HCQ retinopathy of 7.5% overall and 5 times higher odds associated with HCQ dose >5 mg/kg/day, which led to ophthalmology guidelines recommending the avoidance of HCQ dosing >5 mg/kg.1 However, whether this dosing recommendation is applicable to the future risk of HCQ retinopathy is unknown, as is the incidence of severe bullseye retinopathy vs. the mild, pre-symptomatic stage. Furthermore, recent studies have indicated that the use of lower doses of HCQ may increase the risk of lupus flares and hospitalizations.2

Objectives

To determine the incidence of HCQ retinopathy associated with long-term HCQ use and compare them according to HCQ dose.

Methods

We emulated a hypothetical target trial using observational data3 from the US integrated health network Kaiser Permanente Northern California to compare two HCQ weight-based dosing strategies, >5 vs ≤5 mg/kg/day, based on dispensed tablets per year. A secondary analysis evaluated >80% of prescription days covered by dispensed tablets per year with HCQ dose >5 vs ≤5 mg/kg. We included 4,677 patients who initiated and continued HCQ for at least 5 years between 1997-2020. We emulated randomization of treatment strategy by cloning each subject and assigning a replicate to each treatment group.3 We censored replicates if and when they deviated from the assigned treatment group, assessed as the average dose in the first 5 years and annually thereafter. We used inverse probability weighting to account for censoring. The primary outcome was HCQ retinopathy, assessed by expert adjudication of spectral domain-optical coherence tomography (SD-OCT) and graded by severity. All SD-OCTs were prospectively reviewed by an expert ophthalmologist (RM), and a second expert ophthalmologist (MM) reviewed all abnormal scans and a random subset of normal scans. We assessed intra-rater reliability of SD-OCT findings. We used pooled logistic regression to estimate the cumulative incidence of HCQ retinopathy for each HCQ dose strategy from initiation. The odds ratios approximated hazard ratios (HRs) because the outcome at each one-year time block is <5%.

Results

Among 4,677 patients, the mean age at HCQ initiation was 52 years; 83% were female. The racial/ethnic composition included 51% non-Hispanic White, 19% Hispanic, 14% Asian, and 11% Black patients. 756 (16.2%) and 3,921 (83.8%) patients initiated HCQ with the primary definition of the treatment strategies >5 and ≤5 mg/kg/day, respectively. The weighted kappa was 0.80 for SD-OCT reliability. 164 patients developed HCQ retinopathy (100 mild, 38 moderate, and 26 severe cases). The cumulative incidence of retinopathy over 18 years was 37.6% for >5 and 5.7% for ≤5mg/kg of HCQ in our primary analysis. The corresponding risk was 26.5% for >5 and 3.2% for ≤5 mg/kg in our secondary analysis using >80% of prescription days. Compared with ≤5 mg/kg of HCQ, the HRs of retinopathy were 9.65 (95% CI 5.73-16.65) and 10.79 (95% CI 6.40-20.07) for >5 mg/kg using the primary and secondary definitions of HCQ dose categories, respectively (Figure 1).

Conclusion

The risk of HCQ retinopathy associated with long-term adherence to >5 mg/kg dosing was high, approximately 10 times that of ≤5 mg/kg dosing. However, most cases identified during the study were mild and pre-symptomatic, supporting the value of regular screening. These data should be incorporated into individualized decisions about long-term use of HCQ.

References

[1]Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014;132(12):1453-60

[2]Almeida-Brasil CC et al. Flares after hydroxychloroquine reduction or discontinuation: results from the SLICC inception cohort. Ann Rheum Dis 2021 Dec 15, epub ahead of print

[3]Hernán MA, Robins JM. Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available. Am J Epidemiol 2016;183(8):758-64

Disclosure of Interests

April Jorge: None declared, Ronald Melles: None declared, Michael Marmor: None declared, Carol Conell: None declared, Baijun Zhou: None declared, Jingbo Niu: None declared, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart., Grant/research support from: Ironwood and Horizon

Immune reconstitution and survival of patients with parvovirus B19 related pure red cell aplasia after haplo-PBSCT

Parvovirus B19 (PvB19) infection and PvB19 related pure red cell aplasia (PRCA) in recipients with allogeneic hematopoietic stem cell transplantation have been reported sporadically. However, clinical studies with large sample sizes are lacking, especially in patients undergoing HLA-haploidentical peripheral blood stem cell transplantation (haplo-PBSCT). In addition, clinical features, immune reconstitution, and outcomes of these patients are not clear. We conducted a retrospective analysis of 164 patients who received haplo-PBSCT with low-dose anti-thymocyte globulin (ATG) plus low-dose posttransplant cyclophosphamide (PTCy)-based regimen as graft-versus-host disease (GVHD) prophylaxis. We analyzed the incidence of PvB19 related PRCA and compared the clinical characteristics, immune reconstitution, incidence of GVHD, relapse rate, and survival between patients with and without PvB19 related PRCA. A total of 14 (8.5%) recipients developed PvB19 related PRCA after a median of 5.3 months after haplo-PBSCT. These patients with PvB19 related PRCA had slower immune reconstitution, but similar incidences of GVHD, relapse rate, and overall survival compared with recipients without PvB19 related PRCA. PvB19 related PRCA indicated relative delayed and poor immune reconstitution of the recipients early after haplo-PBSCT. PvB19 related PRCA had no effects on GVHD, relapse, and survival.

The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: a Cross-sectional Study in China

Currently, the removal of iodized salt is carried out in high water iodine regions. The present situation of iodine nutrition and the prevalence of thyroid diseases in such regions have not been clearly elucidated. This study aimed to figure out these problems to help render effective measures for cases of abnormal iodine nutrition status. A cross-sectional study was carried out in four areas of Jining and Heze, Shandong Province, China, with different water iodine concentrations (WIC). In total, 1344 adults were enrolled in this study, and data related to their iodine nutrition, thyroid function, and thyroid ultrasonography were collected. Subjects were grouped according to WIC, urine iodine concentration (UIC), serum iodine concentration (SIC), and combined UIC and SIC for analysis. Iodine levels were in excess in the 100 μg/L ≤ WIC < 300 μg/L and WIC ≥ 300 μg/L areas. Compared with the control WIC group (10-100 μg/L), the WIC ≥ 300 μg/L group had a higher prevalence of thyroid autoimmunity (TAI, 21.25% vs. 13.19%, P <0.05), subclinical hypothyroidism (SH, 20.20% vs. 11.96%, P < 0.05), thyroid nodules (TN, 31.75% vs. 18.71%, P < 0.05), and thyroid dysfunction (23.62% vs. 12.26%, P < 0.05). Compared with the UIC control group (100-300 μg/L), high UIC group (≥ 800 μg/L) had a higher prevalence of TN (33.75% vs. 21.14%, P < 0.05) and thyroid dysfunction (25% vs. 14.47%, P < 0.05). Next, compared with the control SIC group (50-110 μg/L), high SIC group (≥ 110 μg/L) had a higher prevalence of TAI (33.80% vs. 14.47%, P < 0.05), SH (23.94% vs. 14.30%, P < 0.05), and thyroid dysfunction (33.80% vs. 15.29%, P < 0.05). Finally, subjects with the highest UIC and the highest SIC also had a higher prevalence of TAI (25.92% vs. 10.97%, P < 0.05), SH (23.45% vs. 10.97%, P < 0.05), TN (34.56% vs. 15.85%, P < 0.05), and thyroid dysfunction (27.16% vs. 13.41%, P < 0.05) than subjects with middle iodine levels. The iodine nutrition of subjects in the WIC ≥ 300 μg/L areas was still in excess after removing iodized salt from their diets. High levels of iodine also increased the prevalence of TAI, SH, TN, and thyroid dysfunction in those areas. Simply removing iodized salt may not be sufficient for high water iodine regions.

Total Body Irradiation-Based Conditioning Regimen Improved the Survival of Adult Patients With T-Cell Lymphoblastic Lymphoma After Allogeneic Peripheral Blood Stem Cell Transplantation

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the consolidation modalities for adult patients with T-cell lymphoblastic lymphoma (T-LBL). However, the optimal conditioning regimen needs to be explored. In the present study, 40 patients with T-LBL undergoing allo-HSCT were retrospectively analyzed, including 23/40 (57.5%) with total body irradiation (TBI)–based conditioning regimen and 17/40 (42.5%) with busulfan (BU)-based regimen. TBI–based regimen significantly increased the cumulative incidence (CI) of grade II to IV acute graft-versus-host disease (aGvHD) as compared with BU-based regimen (13.0% vs 0%, P = 0.000). The relapse risk was significantly lowered in TBI-based group with a 2-year CI of relapse (CIR) of 9.1% as compared with that of 49.6% in BU-based group (P = 0.008). The 1-year and 2-year non-relapse mortalities (NRMs) for all patients were 5.0% and 10.3%, respectively. The 1-year and 2-year NRMs were 8.9% and 16.0% in TBI-based group, and 0.00% and 0.00% in BU-based group (P = 0.140). The 2-year probabilities of overall survival (OS) and relapse-free survival (RFS) were 83.0% [95% confidence interval, 63.4%–100%] and 74.0% (95% confidence interval, 54.4%–93.6%) in TBI-based group, which were higher than that of 35.0% (95% confidence interval, 0.0%–72.2%) and 50.0% (95% confidence interval, 24.5%–75.4%) in BU-based group, respectively (P = 0.020 for OS and P = 0.081 for RFS). In multivariate analysis, TBI-based regimen significantly reduced the risk of relapse [subdistribution hazard ratio (SHR) = 0.030, 95% CI, 0.002–0.040, P = 0.000] and improved the OS [hazard ratio (HR) 0.121, 95% CI, 0.021–0.683, P = 0.017] as an independent prognostic factor. These results suggested that TBI-based regimen might be an optimal choice for adult patients with T-LBL undergoing allo-HSCT.

Lower Absolute Lymphocyte Count Before Conditioning Predicts High Relapse Risk in Patients After Haploidentical Peripheral Blood Stem Cell Transplantation With Low Dose Anti-Thymocyte Globulin/Post-Transplant Cyclophosphamide for GvHD Prophylaxis

Standard anti-thymocyte globulin (ATG) weight-based dosing often resulted in highly variable ATG exposure, which had profound effects on relapse and survival, especially in recipients with relatively low absolute lymphocyte count (ALC) before conditioning. Data regarding rabbit ATG pharmacokinetics and pharmacodynamics in the setting of HLA-haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) is lacking. We conducted a retrospective study on 90 consecutive patients who underwent haplo-PBSCT with low dose rabbit ATG (5 mg/kg) plus low dose post-transplant cyclophosphamide (50 mg/kg) based regimen for graft-versus-host disease (GvHD) prophylaxis. We compared serum concentration of ATG and post-transplant results between patients with ALC<500/μl and ALC≥500/μl before conditioning. Patients with ALC<500/μl had higher ATG concentrations, delayed immune reconstitution, lower incidence of grade II-IV acute GvHD (0 vs. 19.42%, P = 0.043), higher risk of Epstein-Barr virus infection within 100 days post-transplant (47.78% vs. 22.22%, P = 0.020) and 1-year relapse rate (33.33% vs.11.59%, P = 0.041), and lower 1-year overall survival (OS) (52.38% vs.79.71%, P = 0.004), 1-year relapse free survival (RFS) (47.62% vs. 75.36% for RFS, P = 0.014), and 1-year GvHD free relapse-free survival (GRFS) (42.89% vs. 65.22%, P = 0.043). ALC<500/μl before conditioning was a significant poor risk factor for relapse, OS, RFS, and GRFS.

Mediating Effects of Malnutrition on the Relationship between Depressive Symptoms Clusters and Muscle Function Rather than Muscle Mass in Older Hemodialysis Patients

OBJECTIVES

The purpose of this study was to investigate the association and mediation pathways among muscle mass, muscle function (muscle strength and physical performance), and malnutrition with depressive symptoms clusters in the older hemodialysis patients.

DESIGN

A multi-center cross-sectional study.

SETTING AND PARTICIPANTS

A total of 499 patients aged ≥ 60 on hemodialysis from seven facilities in Shanghai of China from 2020 to 2021.

MEASUREMENTS

Muscle mass was assessed by skeletal muscle index(SMI). Muscle strength was measured by handgrip strength, and physical performance was measured via gait speed and Timed Up and Go Test (TUGT). Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Logistic regression and mediation analyses fully adjusted for all potential confounding factors.

RESULTS

Among 499 participants (312 men, mean age 69.2±6.6 years), 108 (21.6%) had depressive symptoms. The muscle strength, physical performance and malnutrition were associated with depressive symptoms. Furthermore, malnutrition significantly mediated the association of muscle function with total, cognitive-affective symptoms. The association of the muscle function with somatic symptoms were mediated by the nutritional status. The mediated proportions of malnutrition in the relationship between physical performance and depressive symptoms clusters were stronger in somatic symptoms than in cognitive-affective symptoms.

CONCLUSIONS

Our findings suggest that muscle function rather than muscle mass may contribute substantially to the development of depressive symptoms clusters in the hemodialysis via malnutrition. The malnutrition mediated stronger in the association of muscle function with somatic symptoms. These findings may help guide clinicians to better diagnose and manage depression in the context of concomitant muscle function and malnutrition.

First-in-human phase 1 study of the anti-TIGIT antibody vibostolimab as monotherapy or with pembrolizumab for advanced solid tumors, including non-small cell lung cancer

BACKGROUND

In this first-in-human phase 1 study, we investigated the safety and efficacy of the anti-TIGIT antibody vibostolimab as monotherapy or in combination with pembrolizumab.

METHODS

Part A enrolled patients with advanced solid tumors and part B enrolled patients with non-small cell lung cancer (NSCLC). Patients received vibostolimab 2.1-700 mg alone or with pembrolizumab 200 mg in part A and vibostolimab 200 mg alone or with pembrolizumab 200 mg in part B. Primary end points were safety and tolerability. Secondary end points included pharmacokinetics and objective response rate (ORR) per RECIST v1.1.

RESULTS

Part A enrolled 76 patients (monotherapy, 34; combination therapy, 42). No dose-limiting toxicities were reported. Across doses, 56% of patients receiving monotherapy and 62% receiving combination therapy had treatment-related adverse events (TRAEs); grade 3-4 TRAEs occurred in 9% and 17% of patients, respectively. The most common TRAEs were fatigue (15%) and pruritus (15%) with monotherapy and pruritus (17%) and rash (14%) with combination therapy. Confirmed ORR was 0% with monotherapy and 7% with combination therapy. In part B, 39 patients had anti-PD-1/PD-L1-naïve NSCLC (all received combination therapy) and 67 had anti-PD-1/PD-L1-refractory NSCLC (monotherapy, 34; combination therapy, 33). In patients with anti-PD-1/PD-L1-naive NSCLC: 85% had TRAEs-the most common were pruritus (38%) and hypoalbuminemia (31%); confirmed ORR was 26%, with responses occurring in both PD-L1-positive and PD-L1-negative tumors. In patients with anti-PD-1/PD-L1‒refractory NSCLC: 56% receiving monotherapy and 70% receiving combination therapy had TRAEs-the most common were rash and fatigue (21% each) with monotherapy and pruritus (36%) and fatigue (24%) with combination therapy; confirmed ORR was 3% with monotherapy and 3% with combination therapy.

CONCLUSION

Vibostolimab plus pembrolizumab was well tolerated and demonstrated antitumor activity in patients with advanced solid tumors, including patients with advanced NSCLC.

Interactive effects of vitamins A and K3 on laying performance, egg quality, tibia attributes and antioxidative status of aged Roman Pink laying hens

Extending laying cycle is a tendency in hen breeding, but egg quality declines as laying hens age. The present study was conducted to investigate the interactive effects of vitamins A and K₃ on laying performance, egg and tibia quality, and antioxidative status of aged Roman Pink laying hens. In a 3 × 3 factorial arrangement, 1 080 87-week-old laying hens were allocated to nine groups with eight replicates in each group. Deficient, adequate and excess vitamins A (0, 7 000 and 14 000 IU/kg) and K₃ (0, 2.0 and 4.0 mg/kg) were supplemented into a basal diet with 1 320 IU/kg of vitamin A and 0.5 mg/kg of vitamin K₃. After 2 weeks of adaption to basal diet, hens were fed corresponding diets for 8 weeks. Vitamins A and K₃ did not significantly affect the laying performance. However, they showed interactive effects on yolk ratio at week 93 as well as tibia weight and diameter (P < 0.05), and hens fed deficient vitamins A and K₃ had the highest yolk ratio and tibia weight, but the lowest tibia diameter. Compared with deficient addition, adequate or excess vitamins A and K₃ increased yolk color at weeks 93 and 97 (P < 0.05). Compared with hens fed deficient or excess vitamins, hens fed adequate vitamins A and K₃ had higher eggshell strength at week 93 or 97 (P < 0.05). Increasing vitamin A elevated plasma total superoxide dismutase (T-SOD) activity and decreased hepatic glutathione peroxidase (GSH-Px) activity (P < 0.05). Excess vitamin K₃ increased hepatic T-SOD activity (P < 0.05). Vitamins A and K₃ exhibited interaction on the activities of antioxidative enzymes in eggshell gland (P < 0.05), and adequate or excess vitamins A and K₃ increased the activities of GSH-Px, T-SOD and catalase (CAT). Adequate and excess vitamin A up-regulated the mRNA expression of GSH-Px1, GSH-Px3 and SOD1 in eggshell gland (P < 0.05). Vitamins A and K₃ showed interactive effects on CAT mRNA expression in eggshell gland (P < 0.05) and hens fed adequate vitamins A and K₃ had the highest CAT mRNA levels. In conclusion, dietary addition of vitamins A and K₃ improved the eggshell quality and yolk color as well as antioxidative status in eggshell gland of aged laying hens. Adequate vitamins A and K₃ showed beneficial effects and excess levels did not exhibit superior effects.

Distance to water source in early childhood affects growth: a cohort study

OBJECTIVES

Approximately 165 million children aged <5 years are at risk of low height-for-age. This study explored whether water quality and distance to water source affected short- and long-term growth, and the critical time windows of such effects.

STUDY DESIGN

This study used data from the China Health and Nutrition Survey (CHNS), which was a cohort study performed in 15 Chinese provinces.

METHODS

Data from the CHNS between 1989 and 2011 were examined. Three cohorts of children who were enrolled at 0-2 years of age in 1989, 1993, and 2000 provided sufficient data for this study. Child height was measured by physicians, and household water supply, including the water quality (safe or unsafe) and distance to the source (in-yard or out-yard), was assessed using a questionnaire when the children were 0-2, 4-6, and 11-13 years of age. Multiple regressions were performed to analyse the associations between water quality and distance to the source at various ages, and height at that age and older ages, with and without adjusting for the household water supply at previous ages. Multiple informant models were created using a generalised estimating equation and these were used to assess whether the exposure coefficients were equal across the three age periods.

RESULTS

A total of 1192 children were included. Water quality was not significantly associated with height over the three age periods. An out-yard water source at the age of 0-2 years was not associated with child height at that age, but it was inversely associated with child height at ages 4-6 and 11-13 years (β = -1.605, 95% confidence interval [CI]: -2.490 to -0.720, and β = -2.817, 95% CI: -4.411 to -1.224, respectively), after adjusting for sociodemographic and economic covariates and baseline child height. Distance to the water source at age 4-6 and 11-13 years was not significantly associated with height. However, significant differences were observed in the associations between distance to water source across the three age periods and height at age 4-6 and 11-13 years (p_int = 0.064 and 0.069, respectively).

CONCLUSIONS

Distance to the water source in early, but not later, childhood exerted a long-term effect on child height. When the water quality is good, efforts should be made to shorten the distance to the source to improve child health and growth.

Safety and efficacy of quavonlimab, a novel anti-CTLA-4 antibody (MK-1308), in combination with pembrolizumab in first-line advanced non-small-cell lung cancer

BACKGROUND

Quavonlimab (MK-1308), a novel anti-CTLA-4 antibody, in combination with pembrolizumab was investigated in a phase I study.

PATIENTS AND METHODS

Dose-escalation (DE) phase: patients with advanced/metastatic solid tumors received an initial flat dose of quavonlimab as monotherapy [25 mg (cohort 1), 75 mg (cohort 2), or 200 mg (cohort 3)] followed by four treatments of the same quavonlimab dose plus pembrolizumab every 3 weeks (Q3W). Dose-confirmation phase (DC): patients with stage IIIB/IV non-small-cell lung cancer (NSCLC) received first-line quavonlimab [25 mg Q3W (arm A), 25 mg Q6W (arm B), 75 mg Q6W (arm C), or 75 mg Q3W (arm E)] plus pembrolizumab. Primary objectives were safety and tolerability and establishment of the recommended phase II dose (RP2D) of quavonlimab when used with pembrolizumab. Objective response rate (ORR) was a secondary endpoint. Efficacy based on PD-L1 expression, tumor mutational burden (TMB), and changes in circulating CD4+/CD8+ cells were exploratory endpoints.

RESULTS

Thirty-nine patients were enrolled in DE [n = 14 (cohort 1); n = 17 (cohort 2); n = 8 (cohort 3)] and 134 in DC [n = 40 (arm A); n = 40 (arm B); n = 40 (arm C); n = 14 (arm E)]. Maximum-tolerated dose was not reached. Grade 3-5 treatment-related adverse events (AEs; graded according to NCI CTCAE v4.03) occurred in 0%, 23.5%, and 75.0% of patients in DE cohorts 1, 2, and 3, respectively, and 35.0%, 30.0%, 35.0%, and 57.1% of patients in DC arms A, B, C, and E, respectively. Efficacy was observed at all dose levels/schedules in patients with NSCLC. ORRs were 40.0% [95% confidence interval (CI), 24.9-56.7; arm A], 37.5% (95% CI, 22.7-54.2; arm B), 27.5% (95% CI, 14.6-43.9; arm C), and 35.7% (95% CI, 12.8-64.9; arm E). PD-L1 expression and total number of circulating CD4+ cells correlated with ORR.

CONCLUSIONS

Quavonlimab 25 mg Q6W plus pembrolizumab demonstrated similar efficacy and a better safety profile among all quavonlimab doses/schedules evaluated; this regimen was the chosen RP2D.

The relation of peripheral and central sensitization to muscle co-contraction: the MOST study

OBJECTIVE

To examine the relation of pain sensitization to altered motor activity in knee OA as assessed by hamstrings muscle co-contraction during maximal effort knee extension.

DESIGN

Medial, lateral, and overall hamstring co-contraction was assessed in the Multicenter Osteoarthritis (MOST) Study cohort using electromyography during isokinetic knee extension at 60°/second. Mechanical temporal summation of pain (TS) was assessed at the right wrist and pressure pain thresholds (PPT) were assessed at the patellae; PPTs were categorized into sex-specific tertiles. Muscle co-contraction was categorized into age- and sex-specific tertiles. We evaluated the relation of measures of sensitization to muscle co-contraction using a generalized logistic regression model.

RESULTS

1633 participants were included: mean age and BMI was 67.3 ± 7.7 years and 30.3 ± 5.6 kg/m2, respectively; 58% were female. Presence of TS was associated with higher overall (OR 1.3, 95% confidence interval (CI) (1.0-1.8)), medial (1.4 (1.0-1.9), and lateral (1.3 (1.0, 1.9)) hamstring co-contraction. The lowest PPT tertile (greater sensitivity) was associated with higher overall (1.5 (1.0, 2.3)) and medial (1.5 (1.0, 2.3)) hamstring co-contraction compared with those in the highest PPT tertile.

CONCLUSION

Greater pain sensitization, as assessed by presence of TS at the wrist and low patellar PPT, was associated with greater overall and medial hamstring co-contraction during knee extension. This provides support to the possibility that peripheral and/or central nervous system alterations may not only affect pain sensitivity, but also motor function.

Gender and age differences in the association between sleep characteristics and fasting glucose levels in Chinese adults

AIM

The present study examined the associations between night-time sleep duration, midday napping duration and bedtime, and fasting glucose levels, and whether or not such associations are dependent on gender and age.

METHODS

This study was a cross-sectional analysis of 172,901 adults aged≥40 years living in mainland China. Sleep duration was obtained by self-reports of bedtime at night, waking-up time the next morning and average napping duration at midday. Fasting plasma glucose (FPG)≥7.0mmol/L was defined as hyperglycaemia. Independent associations between night-time sleep duration, midday naptime duration and bedtime with hyperglycaemia were evaluated using regression models.

RESULTS

Compared with night-time sleep durations of 6-7.9h, both short (<6h) and long (≥8h) night-time sleep durations were significantly associated with an increased risk of hyperglycaemia in women [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.01-1.29 and OR: 1.14, 95% CI: 1.08-1.21, respectively], and revealed a U-shaped distribution of risk in women and no significant association in men. Long midday nap durations (≥1h) were significantly but weakly associated with hyperglycaemia (OR: 1.04, 95% CI: 1.01-1.09) compared with no napping without interactions from gender or age, whereas the association between bedtime and fasting glucose levels did vary according to gender and age.

CONCLUSION

Night-time sleep duration, midday napping duration and bedtime were all independently associated with the risk of hyperglycaemia, and some of the associations between these sleep characteristics and hyperglycaemia were gender- and age-dependent.

Development of an indirect ELISA based on glycoprotein B gene for detecting of Feline herpesvirus type 1

The study was aimed to develop an indirect enzyme-linked immunosorbent assay (ELISA), which can detect specifically Feline herpesvirus type 1 (FHV-1). The primers were designed based on the conserved sequence of FHV-1 glycoprotein B gene. The recombinant protein with reactogenicity was purified as coating antigen of the assay. The indirect ELISA, characterized by high sensitivity showed no cross-reaction with two types of feline virus, had detection limit at 1:2000 dilution. The positive rate of the assay, according to the determined cutoff value (0.25), was basically consistent with Feline Herpes Virus Antibody ELISA kit. In conclusion, the indirect ELISA with high repeatability and reproducibility can be used for detecting FHV-1, and can provide necessary support to related research.

Changing incidence of reported viral hepatitis in China from 2004 to 2016: an observational study

OBJECTIVE

China's national hepatitis burden is high. This study aims to provide a detailed national-level description of the reported incidence of viral hepatitis in China during 2004-2016.

DESIGN

Observational study.

SETTING

Data were obtained from China's National Notifiable Disease Reporting System, and changing trends were estimated by joinpoint regression analysis.

PARTICIPANTS

In this system, 16 927 233 reported viral hepatitis cases occurring during 2004-2016 were identified.

PRIMARY OUTCOME MEASURE

Incidence rates per 100 000 person-years and changing trends were calculated.

RESULTS

There were 16 927 233 new cases of viral hepatitis reported in China from 2004 to 2016. Hepatitis B (HBV) (n=13 543 137, 80.00%) and hepatitis C (HCV) (n=1 844 882, 10.90%) accounted for >90% of the cases. The overall annual percent change (APC) in reported cases of viral hepatitis and HBV were 0.3%(95% CI -2.0 to 0.8, p=0.6) and -0.2% (95% CI -1.6 to 1.2, p=0.8), respectively, showing a stable trend. HBV rates were highest in the 20-29 year old age group and lowest in younger individuals, likely resulting from the universal HBV vaccination. The reported incidence of HCV and hepatitis E (HEV) showed increasing trends; the APCs were 14.5% (95% CI 13.1 to 15.9, p<0.05) and 4.7% (95% CI 2.8 to 6.7, p<0.05), respectively. The hepatitis A (HAV) reporting incidence decreased, and the APC was -13.1% (95% CI -15.1 to -11.0, p<0.05). There were marked differences in the reporting of hepatitis among provinces.

CONCLUSIONS

HBV continues to constitute the majority of viral hepatitis cases in China. Over the entire study period, the HBV reporting incidence was stable, the HCV and HEV incidence increased and the HAV incidence decreased. There were significant interprovincial disparities in the burden of viral hepatitis, with higher rates in economically less-developed areas. Vaccination is important for viral hepatitis prevention and control.

Correction to: Rehmanniae Radix Preparata suppresses bone loss and increases bone strength through interfering with canonical Wnt/β-catenin signaling pathway in OVX rats

There was a mistake in the part of OVX rats model and RRP intervention in the original publication.

[An analysis of assessment results of prevention and control of occupational hazards in a city]

Objective: To investigate the current status of prevention and control of occupational hazards in a city in 2017, to understand the capability to prevent and control occupational hazards and the level of occupational health supervision and management, and to propose measures to urge employers to assume the main responsibility for the prevention and control of occupational diseases. Methods: An analysis of the main factors influencing the prevention and control of occupational hazards in the city was performed to screen out six semi-quantitative assessment indicators (including the training of the main responsible persons and occupational health management personnel in companies) and four qualitative assessment indicators (including the coverage of supervision and inspection of occupational hazards performed by the district safety supervision department) , which could be used to measure the prevention and control effects of regional occupational hazards. Each indicator was scored. The typical investigation method was used to do data review and on-site inspection of 170 companies, 17 district-level occupational health supervision departments, and 16 sub-district (township) occupational health supervision departments in the city from October to December, 2017. The prevention and control of occupational diseases in each district was scored, and the completion rate and completion situation of each indicator in the city were analyzed. Results: The mean score of prevention and control of occupational hazards in the city was 84.9. The scores of two districts were relatively high, being 88.9 and 88.7, respectively; the scores of 9 (52.9%) districts were higher than 85. The pass rate of training for the main responsible persons and occupational health management personnel in companies in the city was 95.9%, the pass rate of occupational health training for workers was 84.7%, the pass rate of occupational health examination for workers was 96.5%, the pass rate for the inspection of occupational hazardous factors in workplaces was 95.3%, the pass rate for notifying occupational hazards in workplaces is 95.9%, and the pass rate for applying the warning signs of occupational hazards in workplaces was 76.5%. Conclusion: The awareness of the importance of prevention and control of occupational hazards in all districts of the city has been increased, but the effectiveness of occupational health training for workers needs to be strengthened. The supply and demand of occupational health technical services are still not matched, and the ways and methods of occupational health supervision and inspection need to be improved.

Interference illumination of three nonzero-order beams for LCOS-based structured illumination microscopy

To avoid the need for a mask and polarisation-adjusting devices, and to solve the problem of low fringe contrast caused by the reflected light along with 0th-order diffraction beam, this paper presents an illumination method using three nonzero-order diffraction beams in liquid crystal on silicon (LCOS)-based structured illumination microscopy. Here, a LCOS-based spatial light modulator (SLM) is used to diffract the collimated light and a rotating frosted film is used to reduce the spatial coherence of the laser; then, the fringe is produced by adjusting the SLM angle to allow three nonzero-order diffraction beams to interfere on the sample surface. Interference fringes with high contrast in all directions can be obtained without considering polarisation control and the removal of the 0th-order diffraction beam, which demonstrates that the optical setup is simple and easy to control. We carried out experiments on a photolithographic pattern on a silicon chip, and the resolution after reconstruction is 210 nm, reaching the theoretical resolution at our experiment condition and nearly half of the Rayleigh resolution limit (100× objective, NA = 0.8), which is 406 nm. LAY DESCRIPTION: SIM has been widely applied in imaging of biological sample owing to its advantage of super-resolution. Commonly the structured illumination is produced by interfering two or three diffractive beams and the fringe contrast affects the reconstruction result directly. In this study about liquid-crystal-on-silicon based structured illumination microscopy (LCOS-based SIM), we presents an illumination method using three nonzero-order diffractive beams. Our method can avoid the need for a mask and the polarisation-adjusting devices, because three-beam interference can reduce the influence of polarisation on the fringe contrast. Besides, 0th-order beam is not used, because reflected light still exists even the grey level of the picture-pixels uploaded to spatial light modulator are all 0, which means the 0th-order beam will bring obvious noise. Using our method, interference fringe with high contrast in all directions can be obtained at a relatively high utilisation rate of laser intensity without considering the control of polarisation. Our setup is simple and easy to control, because the adjustment of the deflection angle of the spatial light modulator can realise the removal of the zero diffraction order. We have analysed and discussed the reasons why the interference of three nonzero-order beams can avoid the influence of polarisation and amplitude. The experiments carried out on a photolithographic pattern on silicon chip showed that the resolution after reconstruction is 210 nm, reaching the half of the Rayleigh resolution limit (100× objective, NA=0.8), which is 406 nm.

Multiple parametric nanoscale measurements with high sensitivity based on through-focus scanning optical microscopy

High-throughput through-focus scanning optical microscopy (TSOM) involves defocusing along the optical axis and capturing a series of defocus images and is useful in optical nanoscale measurement. However, TSOM is usually affected by its optical and mechanical noises. In this study, the issue of sensitivity and application in three-dimensional (3D) multiple parameter measurement of TSOM is investigated. First, a TSOM system with objective scanning and its relative simulation algorithm are proposed. Second, based upon the system and algorithm, an experiment on an isolated Au line is performed and the corresponding matching library is established. Comparing the experimental TSOM image and simulated TSOM images of the library, 3D multiple parameter results of the Au line are extracted. Third, the precision of the system is analysed through a fidelity test particular for through-focus images. According to this study, the system is robust to the optical and mechanical noises and hence could be useful in 3D multiple parametric measurement and high-volume nanomanufacturing.

[A large scale cohort study on AIDS in communities in Dali, Yunnan province, 2014-2015]

Objective: To understand HIV incidence in community residents and epidemiological characteristics of newly detected HIV infection cases in Dali, Yunnan province. Methods: A cohort study was conducted among 146 720 community residents who were tested to be HIV negative during 2010-2011, they were followed-up from June 1, 2014 to May 31, 2015. Results: A total of 136 356 community residents received follow up (92.9%). The follow-up time was 0.23-5.40 years (medium: 3.43 years), cumulatively 459 675 person years, and 78 people were found to be HIV positive. The incidence rate of HIV infection was 0.170/1 000 person years. The incidence rate was 0.037/1 000 person years in age group 15-29 years, 0.288/1 000 person years in age group 30-44 years, 0.210/1 000 person years in age group 45-59 years, 0.204/1 000 person years in age ≥60 years; 0.213/1 000 person years in males, 0.130/1 000 person years in females; 0.248/1 000 person years in Han ethnic group, 0.149/1 000 person years in Minorities; 0.194/1 000 in people with education level ≤ junior middle school, 0.046/1 000 person years in people with education level > junior middle school; 0.070/1 000 person years in the unmarried, 0.194/1 000 person years in the married and 0.425/1 000 person years in the divorced/widowed. Cox proportional hazards regression analysis showed that being male (HR=1.731), aged 30-44 years (HR=13.158), aged 45-59 years (HR=10.329), aged ≥60 years (HR=8.291), unmarried (HR=3.162) and divorced/widowed (HR=2.689) were the risk factors for HIV infection, while the education level > junior middle school (HR=0.132) was the protective factor for HIV infection. Conclusions: By medium 3.43 years follow up, the cohort study showed that incidence rate HIV infection was 0.170/1 000 person years in the community residents in Dali. Male, middle aged and old people, people with low education level, the unmarried and the divorced/widowed had relatively higher risk to be infected with HIV, Close attention should be paid to the prevention and control of AIDS in these populations.

Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level. Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care. Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

Rehmanniae Radix Preparata suppresses bone loss and increases bone strength through interfering with canonical Wnt/β-catenin signaling pathway in OVX rats

Rehmanniae Radix Preparata (RRP) improves bone quality in OVX rats through the regulation of bone homeostasis via increasing osteoblastogenesis and decreasing osteoclastogenesis, suggesting it has a potential for the development of new anti-osteoporotic drugs.

INTRODUCTION

Determine the anti-osteoporotic effect of RRP in ovariectomized (OVX) rats and identify the signaling pathway involved in this process.

METHODS

OVX rats were treated with RRP aqueous extract for 14 weeks. The serum levels of tartrate-resistant acid phosphatase (TRAP), receptor activator of nuclear factor kappa-Β ligand (RANKL), alkaline phosphatase (ALP), and osteoprotegerin (OPG) were determined by ELISA. Bone histopathological alterations were evaluated by H&E, Alizarin red S, and Safranin O staining. Bone mineral density (BMD) and bone microstructure in rat femurs and lumbar bones were determined by dual-energy X-ray absorptiometry and micro-computed tomography. Femoral bone strength was detected by a three-point bending assay. The expression of Phospho-glycogen synthase kinase 3 beta (p-GSK-3β), GSK-3β, Dickkopf-related protein 1 (DKK1), cathepsin K, OPG, RANKL, IGF-1, Runx2, β-catenin, and p-β-catenin was determined by western blot and/or immunohistochemical staining.

RESULTS

Treatment of OVX rats with RRP aqueous extract rebuilt bone homeostasis demonstrated by increasing the levels of OPG as well as decreasing the levels of TRAP, RANKL, and ALP in serum. Furthermore, RRP treatment preserved BMD and mechanical strength by increasing cortical bone thickness and epiphyseal thickness as well as improving trabecular distribution in the femurs of OVX rats. In addition, RRP downregulated the expression of DKK1, sclerostin, RANKL, cathepsin K, and the ratio of p-β-catenin to β-catenin, along with upregulating the expression of IGF-1, β-catenin, and Runx2 and the ratio of p-GSK-3β to GSK-3β in the tibias and femurs of OVX rats. Echinacoside, jionoside A1/A2, acetoside, isoacetoside, jionoside B1, and jionoside B2 were identified in the RRP aqueous extract.

CONCLUSION

RRP attenuates bone loss and improves bone quality in OVX rats partly through its regulation of the canonical Wnt/β-catenin signaling pathway, suggesting that RRP has the potential to provide a new source of anti-osteoporotic drugs.