Multiple autoimmune disorders refractory to glucocorticoids after allogeneic hematopoietic stem cell transplantation: a case report and review of the literature

We report here the case of a 50-year-old man who was first diagnosed with myelodysplastic syndrome with excess blasts-2 (MDS-EB-2) and underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 2019, resulting in complete remission. However, he was diagnosed in 2021 with several autoimmune disorders, including autoimmune hepatitis (AIH), Hashimoto's thyroiditis (HT), and autoimmune hemolytic anemia (AIHA). This is referred as multiple autoimmune syndrome (MAS), which is a rare occurrence after allo-HSCT, as previously noted in the literature. Despite being treated with glucocorticoids, cyclosporine A, and other medications, the patient did not fully recover. To address the glucocorticoid-refractory MAS, a four-week course of rituximab (RTX) at a weekly dose of 100mg was administered, which significantly improved the patient's condition. Thus, this case report underscores the importance of implementing alternative treatments in patients with post-transplant autoimmune diseases, who are glucocorticoid-refractory or glucocorticoid-dependent, and highlights the effectiveness of RTX as second-line therapy.

Excellent Charge Separation of NCQDs/ZnS Nanocomposites for the Promotion of Photocatalytic H2 Evolution

Carbon Quantum dots (CQDs) are widely studied because of their good optical and electronic characteristics and because they can easily generate photocarriers. Nitrogen-doped CQDs (NCQDs) may exhibit improved hydrophilic, optical, and electron-transfer properties, which are conducive to photocatalytic hydrogen evolution. In this paper, NCQD-modified ZnS catalysts were successfully prepared. Under the irradiation of the full spectrum, the H2 evolution rate of the optimal catalyst 0.25 wt % NCQDs/ZnS achieves 5.70 mmol g-1 h-1, which is 11.88, 43.84, and 5.14 times the values of ZnS (0.48 mmol g-1 h-1), NCQDs (0.13 mmol g-1 h-1), and CQDs/ZnS (1.11 mmol g-1 h-1), respectively. Furthermore, it shows good stability, indicating that the modification of NCQDs prevents the photocorrosion and oxidation of ZnS. The enhanced performance is due to NCQD loading, which promotes the separation of photogenerated carriers, optimizes the structures, and increases the specific surface area. This work highlights the fact that NCQD-modified ZnS may afford a new strategy to synthesize ZnS-based photocatalysts with enhanced H2 production performance.

Thyrotropin induces atherosclerosis by upregulating large conductance Ca2+-activated K+ channel subunits

Hypothyroidism is associated with elevated levels of serum thyrotropin (TSH), which have been shown to promote abnormal proliferation of vascular smooth muscle cells and contribute to the development of atherosclerosis. However, the specific mechanisms underlying the TSH-induced abnormal proliferation of vascular smooth muscle cells remain unclear. The objective of this study was to investigate the role of TSH in the progression of atherosclerosis. Our research findings revealed that hypothyroidism can trigger early atherosclerotic changes in the aorta of Wistar rats. In alignment with our in vitro experiments, we observed that TSH induces abnormal proliferation of aortic smooth muscle cells by modulating the expression of α and β1 subunits of large conductance Ca2+-activated K+ (BKCa) channels within these cells via the cAMP/PKA signaling pathway. These results collectively indicate that TSH acts through the cAMP/PKA signaling pathway to upregulate the expression of α and β1 subunits of BKCa channels, thereby promoting abnormal proliferation of arterial smooth muscle cells. These findings may provide a basis for the clinical prevention and treatment of atherosclerosis caused by elevated TSH levels.

Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study

Background

Since the outbreak of COVID-19 in December 2019, countries around the world, including China, have been administering COVID-19 vaccines in response to the pandemic. Our center has observed that treating patients with primary immune thrombocytopenia (ITP) has become more challenging in this context.

Methods

This study compared the treatment response of 25 de novo ITP patients who had received a COVID-19 vaccination (Group 1) with an equal number of de novo ITP patients randomly selected from the 2 years prior to the COVID-19 pandemic (Group 2) by using the Mann-Whitney U test and Fisher's exact.

Results

Patients in both groups had predominantly female gender with similar age and baseline platelet counts. However, on Day 3, the median platelets were 22 and 49 × 109/L, and on Day 7, they were 74 and 159 × 109/L, respectively (P < 0.05). Compared to Group 2, Group 1 showed a suboptimal short-term response to glucocorticoid monotherapy, with a higher proportion of patients requiring combination therapy with other drugs including intravenous immunoglobulin, thrombopoietin receptor agonists, and rituximab. After subgroup analysis, a significant difference was observed in the proportion of patients requiring second-line therapy between the two groups.

Conclusions

Our study suggests that COVID-19 vaccination may lead to a lower response rate to first-line treatment in de novo ITP patients. Nevertheless, it is crucial to acknowledge the inherent limitations in this conclusion. Further studies are needed to confirm these findings and investigate the underlying mechanisms.

Treponema pallidum-induced prostaglandin E2 secretion in skin fibroblasts leads to neuronal hyperpolarization: A cause of painless ulcers

BACKGROUND

Primary syphilis is characterized by painless ulcerative lesions in the genitalia, the aetiology of painless remains elusive.

OBJECTIVES

To investigate the role of Treponema pallidum in painless ulcer of primary syphilis, and the mechanisms underlying painless ulcers caused by T. pallidum.

METHODS

An experimental rabbit model of primary syphilis was established to investigate its effects on peripheral nerve tissues. Human skin fibroblasts were used to examine the role of T. pallidum in modulating neurotransmitters associated with pain and to explore the signalling pathways related to neurotransmitter secretion by T. pallidum in vitro.

RESULTS

Treponema pallidum infection did not directly lead to neuronal damage or interfere with the neuronal resting potential. Instead, it facilitated the secretion of prostaglandin E2 (PGE2) through endoplasmic reticulum stress in both rabbit and human skin fibroblasts, and upregulation of PGE2 induced the hyperpolarization of neurones. Moreover, the IRE1α/COX-2 signalling pathway was identified as the underlying mechanism by which T. pallidum induced the production of PGE2 in human skin fibroblasts.

CONCLUSION

Treponema pallidum promotes PGE2 secretion in skin fibroblasts, leading to the excitation of neuronal hyperpolarization and potentially contributing to the pathogenesis of painless ulcers in syphilis.

Global Epidemiology of Gallstones in the 21st Century: A Systematic Review and Meta-Analysis

BACKGROUND & AIMS

Gallstones are common and associated with substantial health and economic burden. We aimed to comprehensively evaluate the prevalence and incidence of gallstones in the 21st century.

METHODS

We systematically searched PubMed and Embase to identify studies reporting the prevalence and/or incidence of gallstones between January 1, 2000, and November 18, 2023. Pooled prevalence and incidence were calculated using DerSimonian and Laird's random-effects model. We performed subgroup analyses and meta-regression based on age, sex, geographic location, population setting, and modality of detection to examine sources of heterogeneity.

RESULTS

Based on 115 studies with 32,610,568 participants, the pooled prevalence of gallstones was 6.1% (95% CI, 5.6-6.5). Prevalence was higher in females vs males (7.6% vs 5.4%), in South America vs Asia (11.2% vs 5.1%), in upper-middle-income countries vs high-income countries (8.9% vs 4.0%), and with advancing age. On sensitivity analysis of population-based studies, the prevalence of gallstones was 5.5% (95% CI, 4.1-7.4; n = 44 studies), and when limiting subgroup analysis to imaging-based detection modalities, the prevalence was 6.7% (95% CI, 6.1-7.3; n = 101 studies). Prevalence has been stable over the past 20 years. Based on 12 studies, the incidence of gallstones was 0.47 per 100 person-years (95% CI, 0.37-0.51), without differences between males and females, and with increasing incidence in more recent studies.

CONCLUSIONS

Globally, 6% of the population have gallstones, with higher rates in females and in South America. The incidence of gallstones may be increasing. Our findings call for prioritizing research on the prevention of gallstones.

Novel implementation of cardiac magnetic resonance first-pass perfusion imaging for semi-quantitatively evaluating microvascular dysfunction in paediatric patients with Duchenne muscular dystrophy

OBJECTIVES

The current study aimed to assess myocardial microcirculation dysfunction via cardiac magnetic resonance (CMR) first-pass perfusion imaging in children with Duchenne muscular dystrophy (DMD).

METHODS

In total, 67 children with DMD and 15 controls who underwent contrast-enhanced CMR first-pass perfusion imaging were enrolled in this study. CMR first-pass perfusion and late gadolinium enhancement (LGE) sequences were acquired. Further, the global, regional, and coronary artery distribution area perfusion indexes (PI), upslope (%BL), maximum signal intensity (MaxSI), time to maximum signal intensity (TTM), and baseline SI were analysed. The perfusion parameters of the LGE positive (+), LGE negative (-), and control groups were compared. Pearson correlation analysis was performed to assess the association between myocardial microcirculation and conventional cardiac function and LGE parameters.

RESULTS

The LGE+ group had a significantly lower global and apical-ventricular MaxSI than the control group (all P < .05). The left anterior descending arterial (LAD), left circumflex coronary arterial (LCX), and right coronary arterial (RCA) segments of the LGE+ group had a lower upslope and MaxSI than those of the control group (all P < .05). The LAD segments of the LGE- group had a lower MaxSI than those of the control group (41.10 ± 11.08 vs 46.36 ± 13.04; P < .001). The LCX segments of the LGE- group had a lower PI and upslope than those of the control group (11.05 ± 2.84 vs 12.46 ± 2.82; P = .001; 59.31 ± 26.76 vs 68.57 ± 29.99; P = .002). Based on the correlation analysis, the upslope, MaxSI, and TTM were correlated with conventional cardiac function and LGE extent.

CONCLUSIONS

Paediatric patients with DMD may present with microvascular dysfunction. This condition may appear before LGE and may be correlated with coronary artery blood supply and LGE extent.

ADVANCES IN KNOWLEDGE

First-pass perfusion parameters may reveal the status of myocardial microcirculation and reflect the degree of myocardial injury at an earlier time in DMD patients. Perfusion parameters should be analysed not only via global or base, middle, and apical segments but also according to coronary artery distribution area, which may detect myocardial microvascular dysfunction at an earlier stage, in DMD patients with LGE-.

[Clinicopathological study of epithelioid and spindle cell rhabdomysarcoma with EWSR1/FUS-TFCP2 fusion]

Objective: To investigate the clinicopathological and genetic features of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion. Methods: The clinical, morphological and immunohistochemical features of 14 cases of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion diagnosed from January 2019 to December 2022 in the Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed. The cases were all subject to FISH or next generation sequencing for analysis of molecular genetic features. The literature was reviewed. Results: There were 5 males and 9 females, with the age at presentation ranging from 6 to 36 years (mean, 22 years). Tumors occurred in the head and neck (9 cases), pelvic region (2 cases), bladder (one case), right humerus (one case), and the abdominal wall, humerus and pubic at the same time (one case). Presenting symptoms varied by location but often included pain or discomfort. Most of the patients showed aggressive radiographic features with soft tissue extension. The tumors had a median size of 6.6 cm (range, 2-23 cm). The tumors were poorly defined and irregularly shaped. Microscopic examination showed diffuse proliferation of spindle or epithelioid cells. While morphologically high-grade tumors displayed obvious cytological atypia, a high mitotic count and tumor necrosis, low-grade tumors grew in sheets and fascicles composed of spindle, epithelioid cells with moderate or abundant amounts of eosinophilic cytoplasm, without pronounced cytological atypia. The tumor cells expressed Desmin, MyoD1, and Myogenin, as well as ALK, EMA, and CKpan. EWSR1/FUS-TFCP2 gene fusion was detected in 14 cases with next generation sequencing and confirmed by FISH. Six cases had EWSR1-TFCP2 fusions and 8 cases showed FUS-TFCP2 fusions. Follow-up information was available in 13 patients, ranged from 5 to 37 months. At the end of follow-up period, 7 patients died of the disease. Six patients were alive:two cases had local recurrences and metastases, two cases of recurrences, one case of metastasis and one case without recurrences and metastasis. Conclusions: Epithelioid and spindle cell rhabdomysarcomas with EWSR1-TFCP2 or FUS-TFCP2 fusion show a very aggressive clinical course, and more commonly occur in the head and neck. Their genetic hallmark is the presence of EWSR1/FUS-TFCP2 fusions. Familiarity with its clinicopathological characteristics is helpful in avoiding misdiagnoses.

Trends in research related to fetal therapy from 2012 to 2022: a bibliometric analysis

Background

The development of prenatal diagnosis technology allows prompt detection of severe fetal diseases. To address adverse factors that threaten fetal survival, fetal therapy came into existence, which aims to preserve the function after birth to a higher degree and improve the quality of life.

Objective

To conduct a comprehensive bibliometric analysis of studies on fetal therapy in the past decade and explore the research trends and hotspots in this field.

Methods

We conducted a systematic search on the Web of Science Core Collection to retrieve studies related to fetal therapy published from 2012 to 2022. VOSviewer and CiteSpace were used to analyze the key features of studies, including annual output, countries/regions, institutions, authors, references, research hotspots, and frontiers.

Results

A total of 9,715 articles were included after eliminating duplicates. The annual distribution of the number of articles showed that the number of articles published in fetal therapy had increased in the past decade. Countries and institutions showed that fetal therapy is more mature in the United States. Author analysis showed the core investigators in the field. Keyword analysis showed the clustering and emergence frequency, which helped summarize the research results and frontier hotspots in this field. The cocited references were sorted out to determine the literature with a high ranking of fetal therapy in recent years, and the research trend in recent years was analyzed.

Conclusions

This study reveals that countries, institutions, and researchers should promote wider cooperation and establish multicenter research cooperation in fetal therapy research. Moreover, fetal therapy has been gradually explored from traditional surgical treatment to gene therapy and stem cell therapy. In recent years, fetoscopic laser surgery, guideline, and magnetic resonance imaging have become the research hotspots in the field.

Association of increased epicardial adipose tissue derived from cardiac magnetic resonance imaging with myocardial fibrosis in Duchenne muscular dystrophy: a clinical prediction model development and validation study in 283 participants

Background

Epicardial adipose tissue (EAT) contributes to inflammation and fibrosis of the neighboring myocardial tissue via paracrine signaling. In this retrospective study, we investigated the abnormal changes in the amount of EAT in male children with Duchenne muscular dystrophy (DMD) using cardiac magnetic resonance (CMR) imaging. Furthermore, we constructed and validated a nomogram including EAT-related CMR imaging parameter for predicting the occurrence of myocardial fibrosis in patients with DMD.

Methods

This study enrolled 283 patients with DMD and 57 healthy participants who underwent CMR acquisitions to measure the quantitative parameters of EAT, pericardial adipose tissue (PAT), paracardial adipose tissue, and subcutaneous adipose tissue. Late gadolinium enhancement (LGE) was performed to confirm myocardial fibrosis in patients with DMD. The DMD group consisted of 200 patients from institution 1 (the ratio of the training set and the internal validation set was 7:3) and 83 patients from four other institutions (the external validation set). Logistic and least absolute shrinkage and selection operator (LASSO) regression was used to select the optimal predictors and to develop and validate the nomogram model predicting LGE risk in the training set, internal validation set, and external validation set.

Results

Compared with those in healthy controls, some regional EAT thicknesses, areas, and global volumes were significantly higher in patients with DMD, and 41.7% of patients with DMD showed positive LGE. These LGE-positive patients with DMD showed significantly higher EAT volume (median 23.9 mL/m3; P<0.001) and PAT volume (median 31.8 mL/m3; P<0.001) compared with the LGE-negative patients with DMD. Age [odds ratio (OR) 2.0; P<0.001], body fat percentage (OR 1.3; P<0.001), and EAT volume (OR 1.4; P<0.001) were independently associated with positive LGE in the training set. The interactive dynamic nomogram showed superior prediction performance, with a high degree of the calibration, discrimination, and clinical net benefit in the training and validation of the DMD datasets. The area under the curve (AUC) values of the nomogram in the training set, internal validation set, and external validation set were 0.95 [95% confidence interval (CI): 0.91-0.98], 0.97 (95% CI: 0.92-0.99), and 0.95 (95% CI: 0.91-0.99), respectively.

Conclusions

The onset of LGE-based myocardial fibrosis was associated with EAT volume in patients with DMD. Additionally, the nomogram with EAT volumes showed superior performance in patients with DMD for predicting the occurrence of myocardial fibrosis.

Comparison of Pulmonary and Extrapulmonary Models of Sepsis-Associated Acute Lung Injury

To compare different rat models of sepsis at different time points, based on pulmonary or extrapulmonary injury mechanisms, to identify a model which is more stable and reproducible to cause sepsis-associated acute lung injury (ALI). Adult male Sprague-Dawley rats were subjected to (1) cecal ligation and puncture (CLP) with single (CLP1 group) or two repeated through-and-through punctures (CLP2 group); (2) tail vein injection with lipopolysaccharide (LPS) of 10mg/kg (IV-LPS10 group) or 20 mg/kg (IV-LPS20 group); (3) intratracheal instillation with LPS of 10mg/kg (IT-LPS10 group) or 20mg/kg (IT-LPS20 group). Each of the model groups had a sham group. 7-day survival rates of each group were observed (n=15 for each group). Moreover, three time points were set for additional experimental studying in each model group: 4 hours, 24 hours and 48 hours after modeling (every time point, n=8 for each group). Rats were sacrificed to collect BALF and lung tissue samples at different time points for detection of IL-6, TNF-alpha, total protein concentration in BALF and MPO activity, HMGB1 protein expression in lung tissues, as well as the histopathological changes of lung tissues. More than 50 % of the rats died within 7 days in each model group, except for the IT-LPS10 group. In contrast, the mortality rates in the two IV-LPS groups as well as the IT-LPS20 group were significantly higher than that in IT-LPS10 group. Rats received LPS by intratracheal instillation exhibited evident histopathological changes and inflammatory exudation in the lung, but there was no evidence of lung injury in CLP and IV-LPS groups. Rat model of intratracheal instillation with LPS proved to be a more stable and reproducible animal model to cause sepsis-associated ALI than the extrapulmonary models of sepsis.

Nuclear Charge Radius of ^{26m}Al and Its Implication for V_{ud} in the Quark Mixing Matrix

Collinear laser spectroscopy was performed on the isomer of the aluminium isotope ^{26m}Al. The measured isotope shift to ^{27}Al in the 3s^{2}3p ^{2}P_{3/2}^{○}→3s^{2}4s ^{2}S_{1/2} atomic transition enabled the first experimental determination of the nuclear charge radius of ^{26m}Al, resulting in R_{c}=3.130(15)  fm. This differs by 4.5 standard deviations from the extrapolated value used to calculate the isospin-symmetry breaking corrections in the superallowed β decay of ^{26m}Al. Its corrected Ft value, important for the estimation of V_{ud} in the Cabibbo-Kobayashi-Maskawa matrix, is thus shifted by 1 standard deviation to 3071.4(1.0) s.

Efficient photocatalytic hydrogen production by space separation of photo-generated charges from S-scheme ZnIn2S4/ZnO heterojunction

ZnIn2S4/ZnO heterostructures have been achieved by a simple in-situ growth solvothermal method. Under full spectrum irradiation, the optimal photocatalyst 2ZnIn2S4/ZnO exhibits H2 evolution rate of 13,638 (water/ethanol = 1:1) and 3036 (water) μmol·g-1h-1, which is respectively 4 and 5 times higher than that of pure ZnIn2S4. In situ illumination X-ray photoelectron spectroscopy (ISI-XPS) analysis and density functional theory (DFT) calculations show that the electrons of ZnIn2S4 are removed to ZnO through hybridization and form an internal electric field between ZnIn2S4 and ZnO. The optical properties of the catalyst and the effect of internal electric field (IEF) can increase photo-generated electrons (e-)-holes (h+) transport rate and enhance light collection, resulting in profitable photocatalytic properties. The photoelectrochemical and EPR results show that a stepped (S-scheme) heterojunction is formed in the ZnIn2S4/ZnO redox center, which greatly promotes separation of e--h+ pairs and efficient H2 evolution. This research offers an effective method for constructing an efficient S-Scheme photocatalytic system for H2 evolution.

Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle-tracking echocardiography

OBJECTIVES

Blood-flow pattern is an essential factor in cardiovascular development. Recently, blood speckle-tracking echocardiography (BST) based on high-frame-rate ultrasound has emerged as a promising technique for the assessment of blood-flow patterns and properties. The objectives of this study were to determine the feasibility of BST in the fetus and to assess intracardiac blood-flow patterns of fetuses with a congenital heart defect (CHD) using this technique.

METHODS

This was a prospective study consisting of 35 normal fetuses, 35 fetuses with left-sided obstructive lesion (LSOL) and 35 fetuses with right-sided obstructive lesion (RSOL). BST images of fetal intracardiac regions of interest (ROIs), including the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), aortic arch (AA), descending aorta (DAo) and pulmonary artery (PA), were obtained and analyzed. The feasibility of BST was assessed, and blood-flow pattern and number of vortices in the ROIs were recorded.

RESULTS

The median gestational age of the fetuses was 24.7 weeks (range, 19.6-34.3 weeks). BST was feasible in 81.6% of cases, and the cut-off value of depth for an adequate BST image was ≤ 7.9 cm. There were no differences in the presence of vortex/turbulent blood flow in the LV or RV among the three groups. Vortex/turbulent blood flow in the AAo was detected in 0% (0/35), 14.3% (5/35) and 57.1% (20/35) of cases in the control, LSOL and RSOL groups, respectively. The respective values were 5.7% (2/35), 14.3% (5/35) and 51.4% (18/35) for the AA; 0% (0/35), 48.6% (17/35) and 0% (0/35) for the DAo; and 0% (0/35), 40.0% (14/35) and 51.4% (18/35) for the PA. With the exception of the DAo in the RSOL group, vortex/turbulent flow in the great artery ROIs was significantly more common in the LSOL and RSOL groups than in controls (P < 0.01). In the LSOL group, the number of vortices in the AAo, AA, DAo and PA was significantly greater compared with that in controls (P < 0.01). In the RSOL group, the number of vortices in the LV, AAo, AA and PA was significantly greater compared with that in controls (P < 0.01).

CONCLUSIONS

Fetuses with CHD were more likely to exhibit vortex/turbulent blood flow and increased number of vortices in the great arteries compared with healthy controls. Further research is needed to determine the biomechanical effect of blood-flow patterns, especially vortex flow, on fetal cardiovascular structure and function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Occlusal Force Maintains Alveolar Bone Homeostasis via Type H Angiogenesis

Physiologically, teeth and periodontal tissues are exposed to occlusal forces throughout their lifetime. Following occlusal unloading, unbalanced bone remodeling manifests as a net alveolar bone (AB) loss. This phenomenon is termed alveolar bone disuse osteoporosis (ABDO), the underlying mechanism of which remains unclear. Type H vessels, a novel capillary subtype tightly coupled with osteogenesis, reportedly have a role in skeletal remodeling; however, their role in ABDO is not well studied. In the present study, we aimed to explore the pathogenesis of and therapies for ABDO. The study revealed that type H endothelium highly positive for CD31 and endomucin was identified in the periodontal ligament (PDL) but rarely in the AB of the mice. In hypofunctional PDL, the density of type H vasculature and coupled osterix+ (OSX+) osteoprogenitors declined significantly. In addition, the angiogenic factor Slit guidance ligand 3 (SLIT3) was downregulated in the disused PDL, and periodontal injection of the recombinant SLIT3 protein partially ameliorated type H vessel dysfunction and AB loss in ABDO mice. With regard to the molecular mechanism, a mechanosensory signaling circuit, PIEZO1/Ca2+/HIF-1α/SLIT3, was validated by applying cyclic compression to 3-dimensional-cultured PDL cells using the Flexcell FX-5000 compression system. In summary, PDL plays a pivotal role in mechanotransduction by translating physical forces into the intracellular signaling axis PIEZO1/Ca2+/HIF-1α/SLIT3, which promotes type H angiogenesis and OSX+ cell-related osteogenensis, thereby contributing to AB homeostasis. Our findings advance the understanding of PDL in AB disorders. Further therapies targeting SLIT3 may provide new insights into preventing bone loss in ABDO.

[Application and funding status of oral and craniofacial sciences research projects funded by National Natural Science Foundation of China from 2010 to 2021]

Objective: Based on the application and funding status of National Natural Science Foundation of China (NSFC) in the field of oral and craniofacial sciences (H15), we analyzed the current status of basic research of the Oral and Craniofacial Sciences (OCS) in China, and provided the references for the sustainable and efficient funding of basic research and scientific frontier exploration in the field, supporting the construction of talents and teams, and enhancing the development of OCS in China. Methods: The data of both applied and funded grants of H15 in NSFC from 2010 to 2021 were analyzed, including the number of applications and funding, the amount of funding, the funding rate, the research direction and the supporting units. The status of basic research of H15 was summarized. Results: From 2010 to 2021, H15 received 15 060 applications and funded 2 569 grants. The overall funding rate of H15 was 17.06%, and the total funding amount was 1 140.305 million yuan. The applications and funded projects of H15 were mainly focused on the General Projects and Youth Science Fund Projects, accounting for 90.33% (13 604/15 060) and 88.71% (2 279/2 569) of the total number of applications and funded projects, and 78.05% (89 002.5/114 030.5) of the total funding amount. In terms of talent training, the National Science Foundation for Distinguished Young Scholars received 65 applications, and 6 were founded, with a funding rate of 9.23%. The National Science Foundation for Outstanding Young Scholars received 85 applications, and 13 were founded, with a funding rate of 15.29%. In recent years, the number of applications has gradually increased and the number of grants has remained relatively stable. Among the nine sub-categories of H15, the top three in terms of the number of applications and grants were H1502, H1504, and H1507. H1502 (repair and regeneration of oral and craniofacial tissue and organ defects) received 2 760 applications, and 510 were funded. H1504 (periodontal and oral mucosal diseases) received 2 475 applications, and 419 were funded. H1507 (restoration of tooth defects and loss, and correction of dental deformities) received 2 270 applications, and 367 were funded. Peking University and Sichuan University ranked first and second with 1 092 and 1 001 applications, respectively. The top five recipients were Sichuan University (327 items), Peking University (260 items), Wuhan University (204 items), Shanghai Jiao Tong University (198 items) and the Fourth Military Medical University of the People's Liberation Army (193 items). The funding rates were 32.67%, 23.81%, 23.02%, 21.69% and 29.11%, respectively. Conclusions: Under the support of NSFC, the basic research of oral and craniofacial sciences has been developed in an all-round way. In recent years, the talent training of all echelons has increased year by year, the research direction and geographical coverage is comprehensive, and project support organization has its own research focus and discipline advantages, making contributions to the realization of the goal of healthy China and the progress of world medicine.

7-Hydroxy-6-Methoxycoumarin 8-Glucoside (Fraxin) Confers Protection against Ionizing Radiation-Induced Intestinal Epithelial Cell Death Both In Vitro and In Vivo

PURPOSE/OBJECTIVE(S)

The small intestine is highly sensitive to ionizing radiation. Radiation-induced intestinal injury (RIII) limits the therapeutic effect of tumor radiotherapy. However, there are currently few effective treatments available for the prevention or mitigation of RIII. Fraxin, structurally a derivative of a coumarin glucoside extracted from the herbal Cortex Qinpi, has the advantages of low toxicity and relatively low cost. Some studies have proven that Fraxin has anti-inflammatory and antibacterial effects. Our results show that Fraxin can not only promote the regeneration of intestinal stem cells and repair the intestinal structure caused by irradiation but also regulate the composition of gut microbiota and then play an immunomodulatory role through IL-22 signaling pathways, resulting in radioprotective effects.

MATERIALS/METHODS

Human intestinal epithelial cells (HIECs) and intestinal organs were used as experimental models in vitro. The experimental group was irradiated with 6 Gy, detected by a cell counting kit, cell cloning, apoptosis, γ-H2AX and 8-OHdG IF. Male C57BL/6 mice aged 6-8 weeks were given a single dose of whole abdominal irradiation (WAI) at 13 Gy, detected by HE staining, IHC, IF and TUNEL methods, and survival and body weight changes were recorded, fecal samples and small intestinal tissue samples were collected 6 hours and 3 days after irradiation, and the gut microbiota was detected by 16S rRNA sequencing. Whole small intestinal tissue was analyzed by genomic transcript spectrum and RNA sequencing.

RESULTS

Compared with vehicle treatment, Fraxin administration significantly improved the quality of life after WAI and maintained the body weight of mice. In addition, the crypt-villus architecture of the intestinal tracts in mice treated with Fraxin was well preserved, and the number of goblet cells, Lgr5+ intestinal stem cells (ISCs) and their daughter cells, Ki67+ proliferating cells increased significantly, reducing the structural damage caused by radiation. Meanwhile, Fraxin improved the expression of tight junction proteins such as E-cadherin and Claudin-3 after WAI, strikingly reduced the levels of FITC-dextran in serum, maintained the integrity of the intestinal barrier. In addition, we have confirmed that Fraxin can increase the cell viability of HIECs, reduce the 8OHdG fluorescence intensity induced by IR, and reduce γ H2AX lesions and apoptosis. Fraxin administration recovered the disorder of the structure of gut microbiota after irradiation and promoted the expression of probiotics, and KEGG pathway analysis suggested that it was related to immunity. Transcriptional sequencing showed that the IL-22 signaling pathway was significantly activated in the Fraxin treatment group, suggesting that Fraxin may have a protective effect on intestinal radiation through IL-22.

CONCLUSION

In conclusion, Fraxin treatment attenuate RIII by modulating the composition of the gut microbiota and activate the IL-22 signaling pathway to reduce RIII.

Green Tea Derivative (-)-Epigallocatechin-3-Gallate (EGCG) for Prevention of Acute Radiation-Induced Intestinal Injury: A Prospective Phase II Clinical Study in Pelvic Cancer Patients

PURPOSE/OBJECTIVE(S)

Radiation-induced intestinal injury (RIII) remains the most common dose-limiting toxicity following radiotherapy (RT) for pelvic malignancies. However, few efficient and safe methods for the prevention of RIII are available in the clinical practice. Our previous study proved that the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG) efficiently attenuates radiation-induced intestinal injury (RIII) in animal level. Therefore, this prospective phase II clinical study (ChiCTR2100053703) evaluated the efficacy of EGCG in the prevention of RIII.

MATERIALS/METHODS

Cervical or endometrial cancer patients who received adjuvant or radical RT in our department were enrolled, 400mg EGCG was taken daily, and RIII was evaluated weekly according to the RTOG criteria.

RESULTS

Between February 2022 to January 2023, 37 patients were enrolled (30 were cervical cancer and the other 7 were endometrial cancer), and were followed-up regularly. Among them, the majority patients (75.7%, 28 patients) developed grade 0 or 1 RIII, for which no medical intervention was required. Meanwhile, the occurrence of grade 2 RIII was 24.3% (9 patients), which was significantly lower than that in the historical controls (usually 60% to 80%). Besides that, no patients developed grade 3 or worse RIII.

CONCLUSION

In this phase II clinical trial, compared to historical controls, the prophylactic use of EGCG significantly reduced the incidence and severity of RIII in patients receiving pelvic RT. Therefore, EGCG has the potential to become a novel medical countermeasure for the prevention of RIII for pelvic cancer patients.

Probiotic Consortia and their Metabolites Protect Intestine Against Radiation Injury by Improving Intestinal Epithelial Homeostasis

PURPOSE/OBJECTIVE(S)

The intestine is a highly radiosensitive tissue that is susceptible to structural and functional damage due to systemic as well as localized radiation exposure. Unfortunately, no therapeutic agents are available at present to manage radiation-induced intestinal injuries (RIII). Probiotics, especially Lactobacillus or Bifidobacterium, are orally taken as food supplements or microbial drugs by patients with gastrointestinal disorders due to their safety, efficacy, and power to restore the gut microenvironment. Our results demonstrate that probiotic consortia and their metabolites could exert protective roles in the RIII mouse model by restoring the structure of the gut microbiota and regulating redox imbalance. Moreover, the effect of probiotic consortia is better than that of any single probiotic strain.

MATERIALS/METHODS

Male C57BL/6J mice were treated with 13 Gy of whole abdominal irradiation (WAI). Probiotics were administered by gavage before (once a day for 30 days) WAI. The survival and body weight were recorded, while the severity of RIII was evaluated by HE staining, immunohistochemistry (IHC) and TUNEL assay of gut tissues. Meanwhile, stool samples were obtained 3.5 d after irradiation. Gut microbiome were measured by 16S rRNA sequencing, and metabolites were detected by LC-MS analysis. For sterile fecal filtrate (SFF), the supernatants were collected and passed through 70 and 0.2μm filters.

RESULTS

Compared to the control, probiotic consortia (Lactobacillus plantarum, Bifidobacterium longum, Lactobacillus paracasei) treatment significantly increased survival rates by 50% (P<0.05) and improved clinical scores of mice after WAI. HE staining showed that probiotics mitigated RIII, as reflected by the dramatic attenuation of crypt-villus architecture destruction. IHC results showed that probiotic consortia treatment markedly increased the Lgr5+ cells, Paneth cells, and Ki67+ cells (P<0.001) per crypt, indicating that probiotics promoted the proliferation and differentiation of ISCs after WAI. Consistent with the H&E staining, the level of CD4/CD8 was increased by the probiotic consortia compared with that of the control group. The probiotic consortia modulated the structure of the gut microbiota and metabolites in the RIII mouse model. To further investigate the impact of metabolites on RIII, crude probiotic fermentation metabolites were administered to the RIII mouse model. Specifically, mice fed the mixed-metabolite daily for 7 days before IR had significantly more Lgr5+ and Ki67+cells in the SI crypt than mice of control. Moreover, treatment with mixed metabolites resulted in insignificant changes in SOD, MDA, GSH and T-AOC activity compared to the control group in intestinal tissues.

CONCLUSION

In the present study, we demonstrate that probiotic consortia and their metabolites treatment attenuate RIII by modulating the structure and composition of the gut microbiota and regulating redox imbalance.

[Modified gasless trans-subclavian approach endoscopic lateral neck dissection for treatment of papillary thyroid carcinoma: a series of 31 cases]

Objective: To examine the feasibility of the modified gasless trans-subclavian approach endoscopic thyroidectomy for lateral neck dissection (LND) in papillary thyroid carcinoma (PTC). Methods: The clinical data of 31 patients with PTC who underwent modified gasless trans-subclavian approach endoscopic LND in the Department of Head and Neck Surgery, Run Run Shaw Hospital, from January to October 2022 were retrospectively analyzed. There were 2 males and 29 females, aged (32.6±8.3) years (range: 17 to 55 years). The maximum diameter of the primary thyroid lesion (M(IQR)) was 1.06 (1.16) cm (range: 0.53 to 2.44 cm), and the maximum diameter of the metastatic lymph node was (1.04±0.37) cm (range: 0.44 to 1.88 cm). Operation time, postoperative hospital stay, number of lymph nodes dissected, and postoperative complications were recorded. Outpatient follow-up was conducted until November 30, 2022. Results: All operations were successfully completed with the endoscopy approach without conversion to open surgery. The operation time was 160 (20) minutes (range: 100 to 215 minutes), and the postoperative hospital stay was 4 (2) days (range: 2 to 14 days). The number of lymph nodes obtained by dissection in the central and lateral compartment of the neck was 11 (12) (range: 0 to 37) and 34.7±14.8 (range: 15 to 69), respectively. Temporary hypoparathyroidism occurred in 4 cases and all recovered within 1 month after the operation. One case suffered from recurrent laryngeal nerve injury (continuing followed up to assess whether it is a temporary injury). The complication of LND included 1 case of chylous leakage that was recovered with conservative treatment, 1 case of Horner syndrome returned to normal 3 months after surgery. During follow-up, there was no residual tumor or recurrence. Conclusion: The modified gasless trans-subclavian approach endoscopic LND for PTC is feasible, with a thorough dissection and concealed incision.

Advances in non-pharmacological management of Parkinson's disease complicated with blood pressure abnormalities

Parkinson's disease (PD) often presents with autonomic dysregulation, leading to blood pressure irregularities such as neurogenic orthostatic hypotension (nOH), neurogenic supine hypertension (nSH), and postprandial hypotension (PPH). Unfortunately, these conditions remain prevalent and receive insufficient attention in scientific discourse. They not only cause complications like syncope, falls, and fractures but also result in long-term damage to vital organs, diminishing patients' quality of life. Early implementation of appropriate non-pharmacologic management is crucial to prevent severe adverse events later on. This review focuses on the types, clinical characteristics, mechanisms, and common non-pharmacologic management measures for PD complicated by abnormal blood pressure. By promoting early diagnosis, recognizing symptoms of abnormal blood pressure, and employing non-pharmacologic interventions such as health education, dietary adjustments, exercise, and Chinese medicine techniques, we aim to improve patients' symptoms and quality of life while providing practical guidance for managing PD-related blood pressure abnormalities.

A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China

BACKGROUND AND OBJECTIVE

Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU.

METHODS

A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors.

RESULTS

The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates.

CONCLUSIONS

The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.

[Performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation]

Objective: To evaluate the performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation in China. Methods: Data of 41 566 patients who visited 257 smoking cessation clinics equipped with exhaled carbon monoxide detectors from 2019 to 2021 were selected to study the relationship between exhaled carbon monoxide measurement and patients' willingness to quit smoking as well as smoking cessation rate in those who completed follow up. Results: Only 21 470 (51.7%) of the patients received exhaled carbon monoxide measurement in the first visit. Patients who had exhaled carbon monoxide measurement were 1.87 (95%CI: 1.78-1.96) times more likely to have stronger willingness to quit smoking. The follow up results indicated that the patients with exhaled carbon monoxide measurement in the first visit were 1.10 (95%CI: 1.05-1.16) times more likely to quit smoking one month later than those without the measurement, and 1.22 (95%CI: 1.17-1.29) times more likely to quit smoking three months later than those without measurement. Conclusions: Exhaled carbon monoxide measurement can improve patients' willingness to quit smoking and increase smoking cessation rate. However, the testing rate is low in smoking cessation clinics at present. It's important to promote the equipment and utilization of exhaled carbon monoxide detector in smoking cessation clinics.

Low-order fine roots of Picea asperata have different physiological mechanisms in response to seasonal freeze and freeze-thaw of soil

Seasonal soil freezing (F) and freeze-thaw cycles (FTCs) are common natural phenomena in high latitude or altitude areas of the world, and seriously affect plant physiological processes. However, studies on the effect of soil F and FTCs on fine roots are less common, especially in subalpine coniferous forests of western Sichuan, China. We set up a controlled experiment in growth chambers to explore the effects of F and FTCs on low-order fine roots of Picea asperata and differential responses of first-order roots and the first three root orders (1st, 2nd and 3rd order roots combined as a unit). Soil F and FTCs resulted in serious damage to cell membranes and root vitality of low-order fine roots, accompanied by increased MDA content and O₂ ·^- production. FTCs had a stronger effect than F treatment. In turn, low-order fine roots are the unit that responds to cold stress. These roots had increased unsaturated fatty acid contents, antioxidant enzyme activities, osmolytes and plant hormones contents when acclimation to cold stress. The first-order roots were more sensitive to cold stress than the combined first three root orders for several processes (e.g. antioxidant enzymes, osmolytes and hormones) because of their specific structure and physiological activity. This study explains physiological differences in responses of fine roots of different root orders to seasonal soil freezing, which will improve the understanding of fine root heterogeneity and support agriculture and forest management.

Integrating single-cell RNA-seq and spatial transcriptomics reveals MDK-NCL dependent immunosuppressive environment in endometrial carcinoma

Objectives

The tumor microenvironment (TME) play important roles in progression of endometrial carcinoma (EC). We aimed to assess the cell populations in TME of EC.

Methods

We downloaded datasets of single-cell RNA-seq (scRNA-seq) and spatial transcriptome (ST) for EC from GEO, and downloaded RNA-Seq (FPKM) and clinical data of TCGA-UCEC project from TCGA. The datasets were analyzed using R software.

Results

We obtained 5 datasets of scRNA-seq, 1 of ST and 569 samples of RNA-seq. Totally, 0.2 billion transcripts and 33,408 genes were detected in 33,162 cells from scRNA-seq. The cells were classified into 9 clusters, and EC cells were originated from epithelial cells and ciliated cells. Gene set variation analysis (GSVA) indicated that the pathways enriched in the subclusters of epithelial cells and endothelial cells were significantly different, indicating great heterogeneity in EC. Cell-cell communication analyses showed that EC cells emitted the strongest signals, and endothelial cells received more signals than other cells. Further analysis found that subclusters of 1 and 2 of epithelial cells were showed a more malignant phenotype, which may confer malignant phenotype to subcluster of 0 of endothelial cells through MK pathway by MDL-NCL signal. We also analyzed communications between spatial neighbors with ST data and confirmed the findings on MDL-NCL in cell-cell communication. TCGA and GEO analyses indicated that the expression levels of NCL was inversely correlated with ImmuneScore.

Conclusion

Our study revealed EC cells can confer malignant phenotype to endothelial cells by MDK-NCL signal, and NCL is associated with suppressed immune activity. EC cells may shape TME by inhibiting immune cells and “educating” stromal cells via MDK-NCL signal.

Prognostic Value of Cardiac MRI Late Gadolinium Enhancement in Patients with Peripartum Cardiomyopathy: A Retrospective Study

A significant proportion of peripartum cardiomyopathy (PPCM) patients experience persistent heart failure even death, the underneath reason of non-recovery may attribute to the myocardial tissue damage. This study aims to explore the prognostic value of cardiac MRI late gadolinium enhancement (LGE) in women with PPCM, and further establish a predictive model for poor outcomes. Eighty-four consecutively diagnosed women with PPCM underwent cardiac MRI between January 2010 to December 2019. A combined endpoint of poor outcomes (death, New York Heart Association functional class III/IV, heart transplantation or a persistently reduced left ventricular ejection fraction [LVEF)] and complete recovery [an LVEF ≥50%]) were defined. Least absolute shrinkage and selection operator regression and nomogram model were performed to demonstrate prognostic value of cardiac MRI. Higher occurrence of LGE was detected in PPCM women with reached poor outcomes than those who completely recovered (odds ratio: 4.4, 95% CI: 2.6 to 7.5, P<0.001) . PPCM women with LGE+ were more likely to reach combined endpoint of poor outcomes than those with LGE- (odds ratio: 8.2, 95% CI: 1.1 to 59.2, P=0.003). The poor outcome-free rates PPCM women in the group with LGE were lower than those without LGE (log-rank χ²=13.5, P<0.001). LGE presence (hazard ratio [HR]=10.7, 95% CI: 1.38-83.5, P<0.05) and LGE extent (HR=1.2, 95% CI: 1.0-1.3, P<0.05) were prognostic factors for poor outcomes. The predictive nomogram model on LGE showed good discrimination (C index=0.8, 95% CI: 0.6-0.9).Cardiac MRI LGE was an incremental predictive modality for poor outcomes and risk stratification in women with PPCM.

Evaluation of coronary microvascular dysfunction and risk factors in children and youth with Turner syndrome by magnetic resonance myocardial perfusion imaging

OBJECTIVE

Turner syndrome (TS) has an increased predisposition to ischaemic heart disease and the status of coronary microcirculation in TS is largely unknown. This study aims to evaluate myocardial microvascular function in TS using first-pass magnetic resonance perfusion imaging and determine significant risk factors contributing to microvascular dysfunction in the early stage.

DESIGN

Perspective cohort study.

PATIENTS

The study cohort consisted of 67 children and youth with TS and 32 age- and gender-matched controls. Measurements Clinical characteristics, left ventricle (LV) volume and function and cardiovascular magnetic resonance-derived myocardial perfusion parameters were assessed. Univariable and multivariable linear regression analyses were performed to assess the potential risk factors for microvascular dysfunction.

RESULT

Microvascular perfusion decreased in TS in global and segmented myocardium as reflected in the lower upslope_cor and maximum signal intensity (MaxSI) of LV myocardium compared to controls. Multivariable linear regression analysis indicated that age (β = -0.107, 95% confidence interval [CI] = -0.201 to -0.013, p = .026) and being overweight/obese (β = -1.155, CI = -2.134 to -0.176, p = .021) were independent impact factors of microvascular dysfunction. Subgroup analysis showed the upslope_cor of older patients with TS decreased more significantly compared with that of normal controls. Upslope_cor and MaxSI were lower in overweight/obese patients with TS than in patients with normal body mass index (BMI) and controls.

CONCLUSION

Myocardial microvascular dysfunction can occur in children and youth patients with TS. Age and overweight/obesity were the independent risk factors of microvascular dysfunction, which imply the importance of lowering BMI for the prevention of coronary heart disease in young TS population.

Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

OBJECTIVES

Aortic wall stiffness has been reported in infants with tetralogy of Fallot (ToF) and may contribute to long-term aortic dilation even after corrective repair surgery. However, little is known about aortic elasticity in fetuses with ToF and the association with neonatal aortic dilation. The objectives of this study were to assess measures of elasticity of the ascending aorta (AAo) in fetuses with ToF and explore the association with neonatal aortic annular dilation in this population.

METHODS

Seventy-six singleton fetuses with ToF and 76 control fetuses of singleton low-risk pregnancies were enroled into this prospective study. Fetal measures of AAo elasticity, including mean longitudinal strain (MLS), global circumferential strain (GCS) and fractional area change (FAC), were assessed by velocity vector imaging. The z-score of the aortic valve (AV) diameter at the level of the annulus, as a measure of aortic annular dilation, was determined in newborns. Logistic regression analysis was used to investigate the association between fetal measures of AAo elasticity and neonatal aortic annular dilation (defined as an AV annular z-score > 2) in cases with ToF identified prenatally.

RESULTS

Median MLS, GCS and FAC in fetuses with ToF were lower than those in normal fetuses (7.52% vs 12.15% for MLS, 22.05% vs 29.73% for GCS and 34.2% vs 48.3% for FAC, all P < 0.001). Aortic annular dilation was present in 53/76 (69.7%) newborns with ToF. After adjustment for gestational age at fetal echocardiography and birth weight, fetal MLS, GCS and FAC were independently associated with aortic annular dilation neonatally, with odds ratios of 0.66, 0.78 and 0.82, respectively (P < 0.05). The best cut-off values of these prenatal measures of AAo elasticity for predicting neonatal aortic annular dilation in fetuses with ToF were 9.02% for MLS, 23.56% for GCS and 37.2% for FAC (P < 0.001), with areas under the receiver-operating-characteristics curves of 0.94, 0.91 and 0.93, respectively.

CONCLUSION

Measures of AAo elasticity are decreased in fetuses with ToF. Impaired AAo elasticity in the fetal period is associated with aortic annular dilation postnatally. Additional research is needed to evaluate the relationship between the AAo elasticity injury pattern and degeneration of AAo elasticity under stress as well as the long-term outcome in this population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

[Genomic epidemiology of Vibrio parahaemolyticus from acute diarrheal patients in Shenzhen City from 2013 to 2021]

Objective: To characterize the prevalence and genomic epidemiology of Vibrio parahaemolyticus from acute diarrheal patients in Shenzhen City from 2013 to 2021. Methods: Based on the Shenzhen Infectious Diarrhea Surveillance System, acute diarrheal patients were actively monitored in sentinel hospitals from 2013 to 2021. Whole-genome sequencing (WGS) of Vibrio parahaemolyticus isolates was performed, and the genomic population structure, serotypes, virulence genes and multilocus sequence typing were analyzed. Outbreak clusters from 2019 to 2021 were explored based on single-nucleotide polymorphism analysis. Results: A total of 48 623 acute diarrhea cases were monitored in 15 sentinel hospitals from 2013 to 2021, and 1 135 Vibrio parahaemolyticus strains were isolated, with a positive isolation rate of 2.3%. Qualified whole-genome sequencing data of 852 isolates were obtained. Eighty-nine serotypes, 21 known ST types and 5 new ST types were identified by sequence analysis, and 93.2% of strains were detected with toxin profile of tdh+trh-. 8 clonal groups (CGs) were captured, with CG3 as the absolute predominance, followed by CG189. The CG3 group was dominated by O3:K6 serotype and ST3 sequence type, while CG189 group was mainly O4:KUT, O4:K8 serotypes and ST189a and ST189 type. A total of 13 clusters were identified, containing 154 cases. About 30 outbreak clusters with 29 outbreak clusters caused by CG3 strains from 2019 to 2021. Conclusion: Vibrio parahaemolyticus is a major pathogen of acute infectious diarrhea in Shenzhen City, with diverse population structures. CG3 and CG189 have been prevalent and predominant in Shenzhen City for a long time. Scattered outbreaks and persistent sources of contamination ignored by traditional methods could be captured by WGS analysis. Tracing the source of epidemic clone groups and taking precise prevention and control measures are expected to significantly reduce the burden of diarrhea diseases caused by Vibrio parahaemolyticus infection in Shenzhen City.

Chromosome-scale genomics, metabolomics, and transcriptomics provide insight into the synthesis and regulation of phenols in Vitis adenoclada grapes

Vitis adenoclada is a wild grape unique to China. It exhibits well resistance to heat, humidity, fungal disease, drought, and soil infertility. Here, we report the high-quality, chromosome-level genome assembly of GH6 (V. adenoclada). The 498.27 Mb genome contained 221.78 Mb of transposable elements, 28,660 protein-coding genes, and 481.44 Mb of sequences associated with 19 chromosomes. GH6 shares a common ancestor with PN40024 (Vitis vinifera) from approximately 4.26-9.01 million years ago, whose divergence occurred later than Vitis rotundifolia and Vitis riparia. Widely-targeted metabolome and transcriptome analysis revealed that the profiles and metabolism of phenolic compounds in V. adenoclada varieties significantly were differed from other grape varieties. Specifically, V. adenoclada varieties were rich in phenolic acids and flavonols, whereas the flavan-3-ol and anthocyanin content was lower compared with other varieties that have V. vinifera consanguinity in this study. In addition, ferulic acid and stilbenes content were associated with higher expressions of COMT and STSs in V. adenoclada varieties. Furthermore, MYB2, MYB73-1, and MYB73-2 were presumably responsible for the high expression level of COMT in V. adenoclada berries. MYB12 (MYBF1) was positively correlated with PAL, CHS, FLS and UFGT.Meanwhile, MYB4 and MYBC2-L1 may inhibit the synthesis of flavan-3-ols and anthocyanins in two V. adenoclada varieties (YN2 and GH6). The publication of the V. adenoclada grape genome provides a molecular foundation for further revealing its flavor and quality characteristics, is also important for identifying favorable genes of the East Asian species for future breeding.

The potential of 1.5 T magnetic resonance imaging for the evaluation of fetal anomalies of the great vessels

Purpose

To determine the efficacy of 1.5 T magnetic resonance imaging (MRI) for the diagnosis of anomalies of the fetal great arteries with comparison to fetal ultrasound, and to compare image quality between 1.5 T and 3.0 T MRI in fetal imaging of the great arteries.

Methods

We compared the results of postnatal exam or surgery and evaluated the application value of prenatal 1.5 T MRI in the assessment of fetal great-vessel anomalies. To further determine the diagnostic potential of 1.5 T MRI, 23 pregnant women with suspected fetal cardiovascular abnormalities who had undergone ultrasound and 3.0 T MRI were enrolled and compared, respectively.

Results

Prenatal MRI was superior to ultrasound in demonstrating aortic arch and branch abnormalities (sensitivity, 92.86% vs. 83.33%; specificity, 66.67% vs. 20%). The mean quality ratings for fetal MRI at 1.5 T was higher than 3.0 T (P < 0.001). Other than the fast scan speed afforded by 3.0 T MRI, the signal noise ratio (SNR) of 1.5 T MRI were higher than those of 3.0 T MRI; however, the difference in contrast to noise ratio (CNR) between the two imaging modalities was not statistically significant.

Conclusions

1.5 T MRI can achieve an overall assessment of fetal great-vessel anomalies, especially aortic arch and branch abnormalities. Therefore, 1.5 T MRI can be considered a supplementary imaging modality for the prenatal assessment of extracardiac great vessels malformations.

[Standardization of clinical application of mass spectrometry method for measurement of vitamin D in capillary blood of children: a multicenter study]

Objective: To establish the norms and clinical application standards of mass spectrometry method to measure vitamin D in capillary blood. Methods: Following the "Province-City-Hospital" sampling procedure, a cross-sectional sample of 1 655 healthy children under 7 years of age were recruited from 12 provinces, autonomous regions, or municipalities in China from November 2020 to December 2021. Both venous and capillary blood samples from the same individual were collected, for which serum 25(OH)D levels were measured by high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) method. Pearson correlation analysis and linear regression analysis were used to detect the correlation and determine a correction algorithm. The agreement was analyzed using Bland-Altman plot and Kappa statistic. The sensitivity and specificity were evaluated using receiver operating characteristic (ROC) curve method. Results: Venous and capillary 25(OH)D levels of 1 655 healthy children under 7 years of age were 74.25 (59.50, 92.00) and 68.75 (54.44, 86.25) nmol/L, respectively, showed a significant difference(Z=22.14, P<0.001) as well as a highly significant correlation between venous and capillary 25(OH)D levels(r=0.95, P<0.001). Linear regression analysis was then performed to determine the correction algorithm: lg(corrected capillary 25(OH)D)=0.13+0.95×lg(capillary 25(OH)D)(R²=0.90,P<0.001). The deviation between venous and corrected capillary 25(OH)D levels was (0.50±17.50) nmol/L, a difference value that did not reach statistical significance (P>0.05). The cut-off values of capillary blood 25(OH)D values 30.00, 50.00, 75.00 nmol/L corresponding to venous blood 25(OH)D values were 26.59, 45.56, and 69.84 nmol/L, respectively. Good consistency was observed between venous and corrected capillary 25(OH)D levels in clinical diagnosis (Kappa value 0.68-0.81). Corrected capillary 25(OH)D showed a high clinically predictive value (area under curve 0.97-0.99,sensitivity 0.72-0.92,specificity 0.89-0.99). Conclusion: The standardized capillary HPLC-MS/MS method can be used to detect 25(OH)D levels in children clinically.

[A cross-sectional survey and analysis of influencing factors of humanistic of the current status of humanistic care ability of burn specialist nurses]

Objective: To investigate the current status of humanistic care ability of burn specialist nurses and to analyze the influencing factors. Methods: A single-center cross-sectional research method was conducted. From May to August 2020, 63 burn specialist nurses who met the inclusion criteria in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine were selected. Self-made general data questionnaire was used to investigate 17 indexes, including gender, age, professional title, working years, whether received humanistic care training, academic qualification, and caring ability inventory (CAI) was used to evaluate their humanistic care ability. After the nurses were classified by the general data, independent sample t test and one-way analysis of variance were performed on the data to analyze the total score of CAI. The CAI total scores and scores of cognition, courage, and patience of the nurses were compared with the international norm. The factors with statistically significant differences in unvariate analysis were selected for multiple linear regression analysis to screen the independent influencing factors of humanistic care ability of burn specialist nurses. Results: A total of 63 questionnaires were collected in this survey, all of which were valid. Among the 63 nurses, there were 4 males and 59 females, with the age mainly ranging from 20 to 30 years (30 nurses, 47.62%), the professional titles mainly being nurse practitioner (36 nurses, 57.14%), the working years mainly being more than 10 years (28 nurses, 44.44%), 32 nurses not receiving humanistic care training, and academic qualifications mostly being junior college (37 nurses, 58.73%). There were significant differences in the total scores of CAI among nurses with different ages, professional titles, working years, whether received humanistic care training, and academic qualifications (with F values of 53.95, 49.14, and 75.42, t values of 6.08 and -2.82, respectively, P<0.01). The scores of cognition, courage, and patience and the total scores of CAI of nurses in this group were significantly lower than those of international norm (with t values of -2.02, -2.04, -6.19, and -3.89, respectively, P<0.05 or P<0.01). Multiple linear regression analysis showed that age, working years, professional title, and whether received humanistic care training were the independent influencing factors of humanistic care ability of burn specialist nurses (with 95% confidence intervals of 1.91-23.23, 16.25-31.48, 1.05-19.09, and 6.72-31.82, unstandardized coefficient values of 12.57, 23.86, 10.07, and 19.27, respectively, P<0.05 or P<0.01). Conclusions: The humanistic care ability of burn specialist nurses is relatively weak. Age, professional title, working years, and whether received humanistic care training are the independent influencing factors of humanistic care ability of burn specialist nurses.

Association between maternal oxygenation and brain growth in fetuses with left-sided cardiac obstructive lesions

OBJECTIVE

Impaired brain growth has been observed in fetuses with left-sided obstructive lesions (LSOL). Maternal oxygenation (MO) can alter fetal cerebral oxygenation and vascular reactivity. Our aim was to observe whether brain growth improves during MO in fetuses with LSOL.

METHODS

Forty-six fetuses with LSOL and 23 control fetuses were enrolled in this prospective longitudinal study. Fetuses with LSOL were subgrouped into those with MO (LSOL-MO, n = 23) and those without MO (LSOL-nMO, n = 23). Fetal head circumference (HC) and total intracranial volume (TIV) were evaluated serially at 4-week intervals. Brain biometry and growth were analyzed using linear mixed models adjusted for gestational age and sex. Spearman's correlation coefficients were calculated to identify baseline characteristics predictive of brain growth in the LSOL-MO group.

RESULTS

Duration of MO therapy had significant interaction effects on cerebral biometry in fetuses with LSOL. TIV increased more rapidly after 8 weeks of oxygen exposure and HC was larger after 16 weeks of oxygen exposure in the LSOL-MO group compared with the LSOL-nMO group (P &lt; 0.001). The change in TIV at the final time- point relative to the initial timepoint in the LSOL-MO group correlated negatively with the baseline pulsatility index of the middle cerebral artery (r = -0.58, P = 0.003) and baseline myocardial performance index of the left ventricle (r = -0.68, P &lt; 0.001).

CONCLUSIONS

TIV and HC increased faster in fetuses with LSOL which had MO compared with those that did not. Lower cerebral vascular resistance and preserved left heart function at baseline may predict greater cerebral biometric growth during MO. Additional research, including larger serial studies, is needed to confirm these preliminary findings and evaluate the clinical application of MO in this population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Effects of weight loss on bone turnover, inflammatory cytokines, and adipokines in Chinese overweight and obese adults

PURPOSE

Plenty of studies have examined the long term effect of weight loss on bone mineral density. This study aimed to explore the effects of 10% weight loss on early changes in bone metabolism as well as the possible influencing factors.

METHODS

Overweight and obese outpatients (BMI > 24.0 kg/m²) were recruited from the nutrition clinic and followed a calorie-restricted, high-protein, low-carbohydrate diet program. Dietary intake, body composition, serum procollagen type I N-propeptide (PINP), β-Crosslaps, PTH, 25(OH) VitD, a series of inflammatory cytokines and adipokines were measured for the participants before starting to lose weight and after 10% weight loss (NCT04207879).

RESULTS

A total of 75 participants were enrolled and 37 participants achieved a weight loss of at least 10%. It was found that PINP decreased (p = 0.000) and the β-Crosslaps increased (p = 0.035) in female participants. Decreases in PTH (p = 0.001), serum IL-2 (p = 0.013), leptin (p = 0.001) and increases in 25(OH) VitD (p = 0.001), serum ghrelin (p = 0.033) were found in 37 participants after 10% of their weight had been lost. Change in PINP was detected to be significantly associated with change in lean body mass (r = 0.418, p = 0.012) and change in serum ghrelin(r = - 0.374, p = 0.023).

CONCLUSIONS

Bone formation was suppressed and bone absorption was increased in female subjects after a 10% weight loss. Bone turnover was found to be associated with lean body mass and affected by the circulating ghrelin level.

[Clinical validation of the 2020 diagnostic approach for pediatric autoimmune encephalitis in a single center]

Objective: To evaluate the value of the 2020 diagnostic criteria (Cellucci criteria) for pediatric autoimmune encephalitis (AE) in children with suspected AE in a single center. Methods: The clinical data of 121 children hospitalized at the First Affiliated Hospital of Zhengzhou University from October 2019 to October 2021, with a diagnosis of suspected AE, were retrospectively collected and analyzed. The children were divided into definite antibody-positive AE (dAPAE), probable antibody-negative AE (prANAE), possible AE (pAE) and non-AE groups according to the Chinese expert consensus and the Graus criteria. A new diagnosis was made according to the Cellucci criteria which was compared with the clinical diagnosis to evaluate the diagnostic value of the Cellucci criteria. The Mann-Whitney U test, Kruskal-Wallis test, and χ² test were used to compare the differences among groups. The sensitivity and specificity were used to evaluate efficacy of the Cellucci criteria. Results: Among the 121 children, 72 were males and 49 were females, with an age of 10.3 (6.5, 14.0) years at disease onset. There were 99 cases diagnosed as AE according the clinical diagnosis (58 males and 41 females), of which 43 cases were diagnosed as dAPAE, 14 cases as prANAE and 42 cases as pAE, and the other 22 cases were not AE (14 males and 8 females). The top 2 initial symptoms in the 99 children with AE were seizures (53 cases, 53.5%) and abnormal mental behaviors (35 cases, 35.4%). And the most common symptoms during the course of the disease were abnormal mental behaviors (77 cases, 77.8%) and seizures (64 cases, 64.6%). There were statistically differences in the incidence of consciousness disorders, autonomic dysfunctions during the course of the disease and the length of hospitalization among the 4 groups (χ²=21.63, 13.74, H=22.60, all P<0.05). Ninety-six of the 121 children were tested for AE-related antibodies, of which 45 cases (46.9%) were antibody-positive. According to the Cellucci criteria, 42 cases were diagnosed as dAPAE, 34 cases as prANAE and 14 cases as pAE. Compared with the clinical diagnosis, the sensitivity of the Cellucci criteria for the diagnosis of the 3 types of AE were 93.02%, 92.86% and 87.88%, and the specificity were 96.23%, 74.39% and 86.36%, respectively. Conclusions: The Cellucci criteria has a high sensitivity and specificity for the diagnosis of pAE and dAPAE in the clinical management of children with suspected AE, while a high sensitivity but low specificity for the diagnosis of prANAE. Therefore, it is recommended to apply the Cellucci criteria selectively in clinical practice according to the actual situation, especially in the diagnosis of prANAE.

Inhibition of extracellular signal-regulated kinase downregulates endoplasmic reticulum stress-induced apoptosis and decreases brain injury in a cardiac arrest rat model

Cerebral ischemia-reperfusion injury (CIRI) is the predominant cause of neurological disability after cardiac arrest/cardiopulmonary resuscitation (CA/CPR). The endoplasmic reticulum stress (ERs)-induced apoptosis plays an important role in neuronal survival/death in CIRI. Our previous studies reported that the extracellular signal-regulated kinase (ERK) inhibitor, PD98059, alleviates CIRI after CA/CPR. Whether ERs-induced apoptosis is involved in the neuroprotection of PD98059 remains unknown. This study aims to investigate the effects of ERK inhibition by PD98059 on ERs-induced apoptosis after CIRI in the CA/CPR rat model. The baseline characteristics of male adult Sprague-Dawley (SD) rats in all groups were evaluated before CA/CPR. The SD rats that survived from CA/CPR were randomly divided into 3 groups (n=12/group): normal saline group (1 ml/kg), dimethylsulfoxide (DMSO, the solvent of PD98059, 1 ml/kg) group, PD98059 group (0.3 mg/kg). Another 12 SD rats were randomly selected as the Sham group. Twenty-four hours after resuscitation, neural injury was assessed by survival rate, neurological deficit scores (NDS) and Nissl staining; apoptosis of brain cells was detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining; mRNA expression and protein levels of ERs-related protein BIP, PERK, ATF4 and CHOP were checked with RT-PCR and Western Blot. The results showed that there were no significant differences in baseline characteristics before CA/CPR among all groups. PD98059 significantly improved survival rate and NDS, increased the Nissl bodies in neurons, reduced apoptosis, downregulated the mRNA transcription and expression levels of BIP, PERK, ATF4 and CHOP at 24 h after CA/CPR. Our results demonstrate that inhibition of ERK by PD98059 alleviates ERs-induced apoptosis via BIP-PERK-ATF4-CHOP signaling pathway and mitigates CIRI in the CA/CPR rat model.

P-739 Social and treatment characteristics of women with Uterine Fibroid (UF) with/without Heavy Menstrual Bleeding (HMB), in a commercially insured US population

Study question

Are there differences in patient’s social demographic, clinical and treatment characteristics among patients diagnosed with HMB and/or UF?

Summary answer

Baseline characteristics were similar across all UF-status defined-groups. Differences were observed in education, net-worth and 12-monthfollow-up characteristics. Nearly 60% were prescribed pain meds pre-diagnosis.

What is known already

Uterine leiomyomas (or fibroids) are benign neoplasm that affect women of reproductive age1. In the US, treatment for UF is individualized, dependent on size and location of the fibroids, patient profile, symptom severity and type of diagnosis. Patients may be diagnosed with HMB before UF (HMB-UF), diagnosed with UF first and then HMB (UF-HMB), diagnosed with only HMB (HMB-Only) or UF only (UF-Only). Previous studies indicated that the majority (70%) of women received no prescription medications regardless of surgery status and 40% had pain at time of diagnosis.2,3

Study design, size, duration

Our retrospective real-world observational study included 295,400 women across four cohorts between 10/1/2012 -12/31/2020. The majority (96,961; 44%) had HMB-Only, 46,763 (21%) UF-Only, 35,421 (16%) HMB-UF, and 40,806 (19%) UF-HMB. Patients required 12 months continuous enrollment before index date (earlier of HMB or UF diagnosis date based on cohorts) and 12-months of follow-up unless hysterectomy was observed before 12 months. Surgical and pharmacologic agents explored were based on ACOG guidelines for UF.

Participants/materials, setting, methods

Optum® Socio-Economic Status claims database was used to identify newly diagnosed women 18-55 years old with UF and/or HMB claims, without history of conservative/radical surgery or non-dermatological cancers.

Descriptive analyses were performed for patients’ social demographics and treatment characteristics during pre- and post-index period.

Main results and the role of chance

Across all cohorts,

During the 12-month follow-up, nearly 80% of patients used at least 1 prescribed pain medication compared to nearly 60% at baseline. The increase in pain medication use was mainly driven by increase in NSAIDs, opioids, analgesics, and anti-migraine in all cohorts except HMB-O (Opioids: baseline 24-30% to follow up 41-55%; NSAIDs: 20-21% to 44-53%; analgesics: 6-8% to 19%-33%; anti-migraine: 8-11% to 16-29%).

Limitations, reasons for caution

True incidence of index claims are difficult to estimate. Over-the-counters medications or claims made outside the study period are not captured. Pain medication may be unrelated to UF-associated pain.

Findings only reflect the commercially insured population and may not be generalizable. Claims data provide limited clinical profile and prescribing rationales.

Wider implications of the findings

The majority of the patients in these cohorts experienced pain and were prescribed opioids. Determining the link between the use of pain medication and symptoms of UF and HMB is important, as pain medications do not address HMB.

Trial registration number

Not applicable

P-751 Comparing LNG-IUS 52mg versus hysteroscopic resection in patients with postmenstrual spotting related to a niche in the caesarean scar (MIHYS NICHE Trial)

Study question

Among women with niche-related postmenstrual spotting, is LNG-IUS 52mg superior to hysteroscopic niche resection?

Summary answer

At the 6th month after treatment, the median total bleeding days after LNG-IUS 52mg was 4 days, shorter than 13 days after hysteroscopic niche resection.

What is known already

The rate of caesarean sections (CS) is growing worldwide and the prevalence of niche, one of complications of CS, has increased substantially. Until now, evidence-based clinical guidelines for the treatment of niche are few. In patients with niche-related postmenstrual spotting, there are some studies confirm the effectiveness of a levonorgestrel 52 mg intrauterine system (LNG-IUS) on the niche-related symptoms, while some retrospective studies indicated conflicting results. The effect of LNG-IUS and hysteroscopic niche resection in niche-related spotting has not been studied in any RCT yet.

Study design, size, duration

This is a randomized controlled trial conducted in a university-based hospital from Dec 2019 to Jan 2021. Women who were suffering from niche-related postmenstrual spotting for more than two days and had no fertility intention in the coming 12 months were recruited. After randomisation for LNG-IUS 52mg or hysteroscopic resection, follow-up was performed at the 3rd, 6th, 9th and 12nd month. Based on our protocol, 208 women (104 in each group) were included.

Participants/materials, setting, methods

After informed consent is obtained, eligible women were randomly allocated to LNG-IUS 52mg or hysteroscopic niche resection at 1:1. The primary outcome was the efficacy in reducing postmenstrual spotting at the 6th month after randomisation. The secondary outcomes include menstrual pattern, total bleeding days per month, rate of amenorrhoea, side effects and complications. Student’s t-tests were performed to compare the effective rate in improving postmenstrual spotting between two groups.

Main results and the role of chance

208 women were randomised, finally 101 patients in the LNG-IUS group and 104 in hysteroscopic resection group were included in the intention to treat analysis. Median reduced spotting days maintained within 5 days after hysteroscopic niche resection at the 3rd, 6th, 9th and the 12nd month, while after LNG-IUS treatment it increased from 4 days at the 3rd month to 7 days at the 12nd month.

Participants reported a reduction of spotting days by at least 50% from baseline at one-year follow-up in 91 out of 101 (90.0%) in the LNG-IUS group versus 73 out of 104 (70.2%) in the hysteroscopic niche resection group (Relative Risk 1.3; 95% CI 1.1 to 1.5; p &lt; 0.001). The effectiveness rate increased over time within 1 year after the insertion of LNG-IUS (58.4%, 78.2%, 89.1%, 90.0%, P for trend = 0.042), while no trend change was observed in hysteroscopy group (67.3%, 73.1%, 72.1%, 70.2%, P for trend = 0.625).

In the LNG-IUS group, two women removed their IUS after expulsion and three did so after bleeding symptoms. In the hysteroscopy group, two women got pregnant. No serious complications were observed in either group.

Limitations, reasons for caution

The trial was based in a single centre, which might limit the generalisability of the findings. Meanwhile, this trial was an open-label trial both for patients and for researchers, and a blind method was applied to evaluate the effect of treatment.

Wider implications of the findings

LNG-IUS 52mg is superior to hysteroscopic niche resection in reducing niche related postmenstrual spotting from the 6th month. LNG-IUS has advantages including contraceptive effect, no need for (general) anaesthesia or hospitalisation, easy to insert, fewer complications and lower cost. LNG-IUS should be recommended as the first choice for these women.

Trial registration number

ChiCTR1900025677

[Clinical epidemiological survey of primary liver cancer in Yunnan province from 2005 to 2014]

Objective: To investigate the clinical characteristics and changing trends of primary liver cancer in Yunnan province from 2005 to 2014, in order to provide theoretical basis for the prevention and treatment of liver cancer in this region. Methods: A retrospective survey was used to select inpatient cases of liver cancer who were initially diagnosed and treated in our hospital from 2005 to 2014 with simple random sampling. Patients socio-demographic and clinicopathological characteristics were extracted by a unified and standardized questionnaire, and the data were statistically analyzed. Results: A total of 1000 cases with liver cancer were included, aged (53.2±11.2) years, with a male-to-female ratio of 5.99/1.00. There was no significant change in the gender and age composition ratio of patients in the past 10 years. The proportion of patients with lower education level (primary or junior high school) were increased from 21.8% to 23.4%, and the proportion of patients with relatively higher education level were decreased from 58% to 38.2% (P<0.001). Smokers and non-smokers patients were decreased and increased from 58.8% to 44.4%, and 41.2% to 55.6% (P<0.001). The proportion of drinker patients were decreased from 46.4% to 35.2%. The proportion of patients with advanced liver cancer (stage C and D) were increased, while the proportion of patients with stage A and B showed a downward trend (P<0.001). The proportion of HBsAg-positive patients showed an upward trend, that is, rising from 69% in 2005 to 82% in 2014 (P=0.043). The proportion of HBeAg-positive patients showed a steady trend (P=0.008). The use rate of ultrasound examination in patients with liver cancer were decreased from 91.0% to 58.0% (P=0.001), while the use rate of computed tomography (CT), MRI, and PET/CT examinations were increased from 81.0% to 84.0% (P=0.05), 0 to 22% (P<0.001), and 0 to 3% (P=0.026) between 2005 to 2014. The proportion of surgical patients were increased (P=0.005), but the proportion of interventional patients did not change significantly (P=0.590). Surgery and interventional therapy were the most common treatment methods, and the proportion of patients treated with surgery over the past 10 years showed an upward trend (P=0.005), while the proportion of interventional therapy remained at a high level with no significant change (P=0.590). Conclusion: In Yunnan province, the incidence of liver cancer increases with age, and the proportion of male with liver cancer is almost six times that of women. Moreover, the low positive rate of alpha-fetoprotein levels and advanced clinical stage in this region are presently the main challenges against the liver cancer prevention and treatment. The application scope of CT, magnetic resonance imaging, PET-CT and other examination methods has gradually expanded, but the treatment methods are still mainly surgery and interventional therapy.

AB0805 Levels of Natural Killer Cells in patients with Ankylosing Spondylitis: A meta-analysis

Background

Ankylosing Spondylitis(AS) is a complex chronic inflammatory autoimmune disease that mainly affects the spine. Natural Killer (NK) cells are classified among the recently discovered innate lymphoid cell subsets and have capacity to influence both innate and adaptive immune responses. However, the status of NK cells remains debated in AS.

Objectives

This study aims to clarify the level of peripheral NK cells in AS patient.

Methods

We used CNKI, CBM, Wanfang data and Chinese science, scientific and technological journal data, PubMed, Embase, Web of science, Cochrane library and Medline to collect relevant literature data, and sorted out the proportion of NK cells in AS patients. Random effects were selected to assess pooled data, inconsistency was assessed using I-squared index (I2), and Egger’s test was used to assess potential publication bias (STATA v.12.0).

Results

A total of 11 case-control studies involving 561 AS patients and 592 healthy controls (HC) were included in this study. AS patients had a significantly lower proportion of CD16+CD19+NK cells compared with HCs［SMD=-0.41, 95%CI (-0.71,-0.11), P<0.05,］(Figure 1), with no publication bias according to Egg’s test[t=0.50, P=0.63].

Conclusion

The proportion of of CD16+CD19+ NK cells in AS patients was significantly reduced, suggesting disturbance of NK closely involved in the pathogenesis of AS.

Table 1.

Summary of study characteristics of included records.

AuthorPublish yearEIaQbCase numbersNK cell’s definitionData TypeMean % of NK cell(mean(or median)±SD)ASHCQian Liu202147121120CD16+CD56+OriginalAS:17.6HC:138.9Yu Zhang2019463941CD16+CD56+OriginalAS:22.78HC:61.12Wei Hu2019466040CD16+CD56+OriginalAS:13.3HC:48.1Liyuan Zhu2016473030CD16+CD56+OriginalAS:16.23HC:44.58Hua Liu2012456030CD16+CD56+OriginalAS:29.99HC:49.5Yongfang Wang2012466044CD16+CD56+OriginalAS:14.04HC:60.12Yuehu Hua2012473632CD16+CD56+OriginalAS:31.1HC:59.8Li Ma2011464320CD16+CD56+OriginalAS:24.98HC:38.15Xuehua Ma2011463632CD16+CD56+OriginalAS:31.1HC:59.8Yong-Wook Park20094741173CD16+CD56+CalculatedAS:25.4HC:190.4Li Ma2004473530CD16+CD56+OriginalAS:33.48HC:52.37

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 82001740).

Disclosure of Interests

None declared