Clinical characteristics and prognosis of non-APAP drug-induced acute liver failure: a large multicenter cohort study

BACKGROUND

There is growing recognition of natural history, complications, and outcomes of patients who develop non-acetaminophen (APAP) drug-induced acute liver failure (ALF). To clarify high-risk factors and develop a nomogram model to predict transplant-free survival (TFS) in patients with non-APAP drug-induced ALF.

METHODS

Patients with non-APAP drug-induced ALF from 5 participating centers were retrospectively analyzed. The primary endpoint was 21-day TFS. Total sample size was 482 patients.

RESULTS

Regarding causative agents, the most common implicated drugs were herbal and dietary supplements (HDS) (57.0%). The hepatocellular type (R ≥ 5) was the main liver injury pattern (69.0%). International normalized ratio, hepatic encephalopathy grades, the use of vasopressor, N-acetylcysteine, or artificial liver support system were associated with TFS and incorporated to construct a nomogram model (drug-induced acute liver failure-5, DIALF-5). The AUROC of DIALF-5 for 7-day, 21-day, 60-day, and 90-day TFS in the internal cohort were 0.886, 0.915, 0.920, and 0.912, respectively. Moreover, the AUROC of DIALF-5 for 21-day TFS had the highest AUROC, which was significantly higher than 0.725 of MELD and 0.519 of KCC (p < 0.05), numerically higher than 0.905 of ALFSG-PI but without statistical difference (p > 0.05). These results were successfully validated in the external cohort (147 patients).

CONCLUSIONS

Based on easily identifiable clinical data, the novel DIALF-5 model was developed to predict transplant-free survival in non-APAP drug-induced ALF, which was superior to KCC, MELD and had a similar prediction performance to ALFSG-PI but is more convenient, which can directly calculate TFS at multiple time points.

Association of chronic hepatitis B infection with hepatic steatosis and injury in nonalcoholic fatty liver disease children

BACKGROUND

The influence of chronic hepatitis B infection (CBI) on hepatic steatosis, necroinflammation, and fibrosis in nonalcoholic fatty liver disease (NAFLD) population was unclear. We aimed to investigate the effect of CBI on hepatic steatosis and assess the association between NAFLD co-existed CBI and hepatic injury in NAFLD pediatric population.

METHODS

Consecutive hospitalized children with biopsy-proven NAFLD with or without CBI were included. Hepatic steatosis, necroinflammation and fibrosis were evaluated by NASH CRN system and/or METAVIR scoring system, appropriately. Using multivariate logistic analysis, we identified variables associated with hepatic steatosis and liver injury.

RESULTS

Of 223 biopsy-proven NAFLD children, 161 were NAFLD without CBI, and 62 were NAFLD co-existed CBI. Grouped by mild, moderate and severe hepatic steatosis, there was an inverse association between CBI and the severity of hepatic steatosis [odd ratio (OR) 0.037, 95% confidence interval (CI) 0.014-0.098]. In addition, we explored the relationship between CBI and hepatic necroinflammation and fibrosis in NAFLD children. Hepatic necroinflammation and fibrosis, respectively, were divided into two groups according to severity. And CBI was positively associated with hepatic necroinflammation (OR 6.125, 95%CI 1.958-19.158). However, there was no statistically independent association between CBI and significant hepatic fibrosis.

CONCLUSIONS

CBI was inverse associated with the grade of steatosis and positively associated with severe hepatic necroinflammation, and does not appear to affect significant hepatic fibrosis in pediatric NAFLD children.

A novel chemokine biomarker to distinguish active tuberculosis from latent tuberculosis: a cohort study

BACKGROUND

Interferon-γ release assays (IGRAs), which are widely used to diagnose tuberculosis (TB), cannot effectively discriminate latent TB infection (LTBI) from active TB (ATB). This study aimed to identify potential antigen-specific biomarkers for differentiating LTBI cases from ATB cases.

METHODS

Ongoing recruitment was conducted of individuals meeting study inclusion criteria at Beijing Chest Hospital from May 2020 to April 2022; 208 participants were enrolled and assigned to three groups: HC (60 healthy controls), LTBI (52 subjects with LTBI) and ATB (96 ATB patients). After participants were assigned to the discovery cohort (20 or 21 subjects/group), all others were assigned to the verification cohort. Discovery cohort blood levels of 40 chemokines were measured using Luminex assays to identify chemokines that could be used to discriminate LTBI cases from ATB cases; candidate biomarkers were verified using enzyme-linked immunosorbent assay-based testing of validation cohort samples.

RESULTS

Luminex results revealed highest ATB group levels of numerous cytokines, growth factors and chemokines. Receiving operating characteristic curve-based analysis of 40 biomarkers revealed CCL8 (AUC = 0.890) and CXCL9 (AUC = 0.883) effectively discriminated between LTBI and TB cases; greatest diagnostic efficiency was obtained using both markers together (AUC = 0.929). Interpretation of CCL8 and CXCL9 levels for validation cohort IGRA-positive subjects (based on a 0.658-ng/ml cutoff) revealed ATB group CCL8-based sensitivity and specificity rates approaching 90.79% and 100.00%, respectively.

CONCLUSION

TB-specific chemokines hold promise as ATB diagnostic biomarkers. Additional laboratory confirmation is needed to establish whether CCL8-based assays can differentiate between ATB and LTBI cases, especially for bacteriologically unconfirmed TB cases.

A40 GUT MICROBIOTA PROMOTES NUTRIENT AVAILABLITY AND PATHOGENESIS OF AN ATTACHING/ EFFACING BACTERIAL PATHOGEN

Background

Our gut microbiota plays an important role in protecting the gastrointestinal (GI) tract from invading enteric pathogens. Much of this colonization resistance is mediated by limiting nutrient availability, however, enteric pathogens have evolved strategies to subvert this competition, utilizing commensal metabolites to facilitate their infection. Access to nutrients is not only crucial for a pathogen’s metabolic fitness, but can also drive the expression of virulence factors, a process high in energy demands. In addition, enteric pathogens, such as the attaching and effacing (A/E) bacterium Citrobacter rodentium, must cross the colonic mucus layer that normally prevents their direct access to the underlying epithelium. Intestinal mucus is comprised of highly glycosylated mucins, with the sugar sialic acid frequently occupying the terminal position of their O-glycan side chains. We hypothesize that C. rodentium utilizes commensal-liberated mucin sugars, such as sialic acid, as nutrients and signals to promote its virulence.

Purpose

This study investigates the mechanisms by which A/E pathogens reach the colonic mucosal surface, and the role played by commensal microbes in facilitating the infection.

Method

Expression of virulence factors secreted by C. rodentium in the presence or absence of sialic acid was analyzed by SDS-PAGE and mass spectrometry. Next, we infected specific-pathogen free (SPF), germfree (GF), and previously GF C57Bl/6 mice mono-colonized with Bacteroides thetaotaomicron, a mucus-degrading commensal, to examine their susceptibility to C. rodentium and to measure the levels of free sialic acid in their feces.

Result(s)

Sensing of sialic acid by C. rodentium, was found to induce the secretion of several key virulence proteins, enhancing the pathogen’s migration across the colonic mucus layer and adhesion to the underlying epithelium. Access to sialic acid within the gut environment was enhanced in the presence of microbiota, as the levels of free sialic acid were low in GF mice. Interestingly, despite GF mice carrying very high C. rodentium burdens, passage across the mucus layer and infection of their colonic epithelium was impaired as compared to SPF mice. Notably, B. thetaotaomicron was found to degrade whole mucus in vitro, facilitating its consumption by C. rodentium for growth, while B. thetaotaomicron mono-colonized GF mice showed increased susceptibility to colonic infection by C. rodentium.

Conclusion(s)

We demonstrate that although commensal microbes promote colonization resistance, as an A/E pathogen infection establishes, specific commensal bacteria accelerate infection in the GI tract by releasing an important nutrient, ie. sialic acid, from mucus. Access to sialic acid promotes C. rodentium virulence by inducing the key virulence factors that facilitate its translocation across the mucus layer as well as adhesion to the epithelium, thereby expediting disease progression.

Please acknowledge all funding agencies by checking the applicable boxes below

CCC, CIHR, Other

Please indicate your source of funding;

CH.I.L.D. Foundation

Disclosure of Interest

None Declared

Alanine Aminotransferase and Bilirubin Dynamic Evolution Pattern as a Novel Model for the Prediction of Acute Liver Failure in Drug-Induced Liver Injury

Aims: To develop, optimize, and validate a novel model using alanine aminotransferase (ALT) and total bilirubin (TB) dynamic evolution patterns in predicting acute liver failure (ALF) in drug-induced liver injury (DILI) patients.

Methods: The demographics, clinical data, liver biopsy, and outcomes of DILI patients were collected from two hospitals. According to the dynamic evolution of ALT and TB after DILI onset, the enrolled patients were divided into ALT-mono-peak, TB-mono-peak, double-overlap-peak, and double-separate-peak (DSP) patterns and compared. Logistic regression was used to develop this predictive model in both discovery and validation cohorts.

Results: The proportion of ALF was significantly higher in patients with the DSP pattern than in the ALT-mono-peak pattern and DOP pattern (10.0 vs. 0.0% vs. 1.8%,p &lt; 0.05). The area under receiver operating characteristic curve (AUROC) of the DSP pattern model was 0.720 (95% CI: 0.682–0.756) in the discovery cohort and 0.828 (95% CI: 0.788–0.864) in the validation cohort in predicting ALF, being further improved by combining with international normalized ratio (INR) and alkaline phosphatase (ALP) (AUROC in the discovery cohort: 0.899; validation cohort: 0.958). Histopathologically, patients with the DSP pattern exhibited a predominantly cholestatic hepatitis pattern (75.0%, p &lt; 0.05) with a higher degree of necrosis (29.2%, p = 0.084).

Conclusion: DILI patients with the DSP pattern are more likely to progress to ALF. The predictive potency of the model for ALF can be improved by incorporating INR and ALP. This novel model allows for better identification of high-risk DILI patients, enabling timely measures to be instituted for better outcome.

NASA GEOS Composition Forecast Modeling System GEOS-CF v1.0: Stratospheric Composition

The NASA Goddard Earth Observing System (GEOS) Composition Forecast (GEOS-CF) provides recent estimates and 5-day forecasts of atmospheric composition to the public in near-real time. To do this, the GEOS Earth system model is coupled with the GEOS-Chem tropospheric-stratospheric unified chemistry extension (UCX) to represent composition from the surface to the top of the GEOS atmosphere (0.01 hPa). The GEOS-CF system is described, including updates made to the GEOS-Chem UCX mechanism within GEOS-CF for improved representation of stratospheric chemistry. Comparisons are made against balloon, lidar, and satellite observations for stratospheric composition, including measurements of ozone (O₃) and important nitrogen and chlorine species related to stratospheric O₃ recovery. The GEOS-CF nudges the stratospheric O₃ toward the GEOS Forward Processing (GEOS FP) assimilated O₃ product; as a result the stratospheric O₃ in the GEOS-CF historical estimate agrees well with observations. During abnormal dynamical and chemical environments such as the 2020 polar vortexes, the GEOS-CF O₃ forecasts are more realistic than GEOS FP O₃ forecasts because of the inclusion of the complex GEOS-Chem UCX stratospheric chemistry. Overall, the spatial patterns of the GEOS-CF simulated concentrations of stratospheric composition agree well with satellite observations. However, there are notable biases-such as low NO _x and HNO₃ in the polar regions and generally low HCl throughout the stratosphere-and future improvements to the chemistry mechanism and emissions are discussed. GEOS-CF is a new tool for the research community and instrument teams observing trace gases in the stratosphere and troposphere, providing near-real-time three-dimensional gridded information on atmospheric composition.

A9 SIALIC ACID METABOLISM PLAYS A KEY ROLE IN INTESTINAL FITNESS AND VIRULENCE OF AN ATTACHING/ EFFACING BACTERIAL PATHOGEN

Background

The gastrointestinal (GI) mucus barrier acts as an important interface between the host and luminal gut microbes, beyond its role in limiting direct contact between noxious luminal agents and the underlying intestinal epithelium. Mucus is comprised of highly glycosylated mucin proteins, modified by O-glycan side chains, formed by five sugar monomers, including sialic acid. Sialic acid frequently occupies the terminal position of O-glycans and can be cleaved by microbial sialidases. We hypothesize that upon entering their hosts, enteric pathogens, such as the attaching and effacing (A/E) family (EHEC, EPEC and Citrobacter rodentium) metabolically adapt to their intestinal environment, and express key virulence factors by sensing and metabolizing mucin sugars, such as sialic acid.

Aims

Investigate the role of sialic acid in regulating the fitness and virulence strategies of the A/E pathogen C. rodentium within the GI environment.

Methods

C57Bl/6 mice were orally infected with either wildtype (WT) or mutant strains of C. rodentium to study bacterial pathogenicity in vivo. Sialic acid was localized in mouse colonic tissue sections through lectin staining, and quantified in mouse feces and mucus scrapings using a commercial kit. Protein secretion by C. rodentium, in the presence or absence of sialic acid was analyzed by SDS-PAGE and mass spectrometry. Intestinal epithelial cell lines were infected with enteropathogenic E. coli (EPEC) or C. rodentium to examine bacterial adherence.

Results

Sialic acid was expressed widely in the GI tracts of mice, primarily in the colonic mucus layer and by intestinal goblet cells. Both EPEC and C. rodentium were found to take up and metabolize sialic acid through the transporter NanT. A C. rodentium strain deficient in sialic acid uptake ( ΔnanT) was dramatically impaired in colonizing the intestines of mice and was rapidly cleared. Sialic acid also impacted C. rodentium’s virulence by inducing the secretion of two key virulence factors, which significantly enhanced the pathogen’s adhesion to intestinal epithelial cells. Moreover, sialic acid increased C. rodentium’s ability to degrade mucus, due to the increased production of these two secreted virulence factors.

Conclusions

We demonstrate that sialic acid, a mucin-derived sugar, is an essential nutrient for A/E pathogens to thrive and expand within their host’s intestines. Moreover, sialic acid enhances pathogen virulence by inducing secretion of two important virulence factors, which increase adhesion to the epithelium and promote the degradation of mucus.

Funding Agencies

CCC, CIHRCH.I.L.D. Fdn

[Comparison of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease]

OBJECTIVE

To compare the practicability and clinical value of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease (COPD).

METHODS

We retrospectively analyzed the clinical data of 28 patients with acute exacerbation of COPD admitted to our hospital between November, 2020 and January, 2021. All the patients were assessed with percentage of predicted forced expiratory volume in 1 second (FEV1% pred), COPD assessment test (CAT), modified British Medical Research Council (mMRC), baseline dyspnea index (BDI), clinical COPD questionnaire (CCQ), St. George's respiratory questionnaire (SGRQ), BODE index, Hamilton Depression Rating Scale (HDRS) at admission and with CAT, mMRC, transition dyspnea index (TDI), CCQ, SGRQ, and HDRS at 1 month after discharge. The correlations among FEV1% pred, CAT, mMRC, BDI, CCQ, SGRQ, BODE and HDRS at admission were analyzed. We also compared the TDI and scores of CAT, mMRC, CCQ, SGRQ, and HDRS at 1 month after discharge among the patients using single (n=8), dual (n=10) or triple inhaled medications (n=10) after discharge.

RESULTS

Among these patients, FEV1% pred was moderately correlated with SGRQ and BDI (r=-0.66, r=0.61; P < 0.01), and CCQ activity score was closely correlated with mMRC, SGRQ activity score and BDI (r=0.82, r=0.92, r=-0.89; P < 0.01). SGRQ activity score was closely correlated with mMRC and BDI (r=0.84, r=-0.91; P < 0.01), and SGRQ symptom score was closely correlated with BODE (r=0.80, P < 0.01). SGRQ impact score was moderately correlated with HDRS (r=0.57, P < 0.01). In all the 28 patients, all the evaluation scores except for CCQ mental score and HDRS improved significantly after treatment (P < 0.05). At 1 month after discharge, CCQ total score decreased significantly in single therapy group (P < 0.05); CAT, mMRC, CCQ and SGRQ improved obviously in dual therapy group (P < 0.05); CCQ and SGRQ scores decreased significantly in triple therapy group (P < 0.05); the TDI did not differ significantly among the 3 groups (P>0.05).

CONCLUSION

For patients with COPD, BDI and TDI are recommended over mMRC for assessing dyspnea. CAT, CCQ and SGRQ allow sensitive assessment of the treatment efficacy to serve as routine evaluation tests, and among them SGRQ is the most comprehensive and is thus recommended when sufficient time is allowed. BODE is relatively complex but highly valuable for predicting the patients'survival outcomes. HDRS is recommended for routine screening of depression in patients with COPD.

[A real-world study of 176 cases with aplastic anemia treated in outpatient]

目的

探索真实世界门诊治疗再生障碍性贫血（AA）患者的诊断流程、治疗及疗效。

方法

评估2018年1月至2019年12月门诊治疗176例AA患者的诊断流程、治疗方案及疗效。

结果

患者出现症状至首次就诊中位时间7（5～120）个月，就诊原因包括出血（52.3%）、贫血（51.7%）、感染（6.8%）。诊断流程中168例（95.5%）患者完成髂骨骨髓穿刺（骨穿），仅22例（17.1%）完善了多部位骨穿（胸骨分类）；骨髓活检完成率85.1%（143/168）；只有59.5%（100/168）和58.9%（99/168）完成了骨髓流式免疫分型及染色体核型分析；86例（48.5%）完成阵发性睡眠性血红蛋白尿（PNH）克隆筛查；造血祖细胞培养检查完成率最低，仅45例（26.8%）。环孢素A（CsA）联合雄激素及左旋咪唑为最常见治疗方案，总计77例（43.8%），其次为CsA联合雄激素45例（25.6%），单用CsA者24例（13.6%），单用雄激素者16例（9.1%），14例（7.9%）患者确诊后选择中药或未治疗。根据门诊复诊频率将176例患者分为复诊规律组（每年≥4次）130例（73.9%）和复诊欠规律组（每年<4次）46例（26.1%）。复诊规律组6个月有效率较高（52.5%对28.0%，P＝0.005），12个月高质量缓解率更好（40.7%对16.7%，P＝0.027），24个月复发率更低（4.4%对36.4%，P＝0.001）。

结论

真实世界治疗的AA患者诊断流程需重视多部位骨穿检查并完成PNH克隆筛查、流式免疫分型、染色体核型分析及造血祖细胞培养检查；门诊规律复诊患者可获得高质量缓解，复发率低，推荐每年至少复诊4次。

Correlations of the expression of γδ T cells and their co-stimulatory molecules TIGIT, PD-1, ICOS and BTLA with PR and PIBF in the peripheral blood and decidual tissues of women with unexplained recurrent spontaneous abortion

Semi-allogeneic embryos are not rejected by the maternal immune system due to maternal-fetal immune tolerance. Progesterone (P) receptor (PR)-expressing γδ T cells are present in healthy pregnant women. In the presence of P, these cells secrete an immunomodulatory protein called progesterone-induced blocking factor (PIBF), which can facilitate immune escape and is important in preventing embryonic rejection. This work investigated the correlations of the expression of γδ T cells and their co-stimulatory molecules T cell immunoglobulin and ITIM domain (TIGIT), programmed cell death 1 (PD-1), inducible co-stimulator (ICOS) and B and T lymphocyte attenuator (BTLA) with progesterone receptor (PR) and progesterone-induced blocking factor (PIBF) in peripheral blood and decidual tissue in women with unexplained recurrent spontaneous abortion (URSA) and normal pregnant (NP) women. We confirmed that γδ T cell proportions and PIBF expression in the peripheral blood and decidua of URSA women decreased significantly, while PR expression in decidua decreased. However, TIGIT, PD-1, ICOS and BTLA expression in γδ T cells in peripheral blood did not change, while TIGIT and PD-1 expression in γδ T cells in decidua increased significantly. Under the action of PHA-P (10 µg/ml), co-blocking of TIGIT (15 µg/ml) and PD-1 (10 µg/ml) antibodies further induced γδ T cell proliferation, but PIBF levels in the culture medium supernatant did not change. At 10^-10 M P, γδ T cells proliferated significantly, and PIBF concentrations in the culture medium supernatant increased. γδ T cells co-cultured with P, TIGIT and PD-1 blocking antibodies showed the most significant proliferation, and PIBF concentrations in the culture medium supernatant were the highest. These results confirm that P is necessary for PIBF production. The TIGIT and PD-1 pathways participate in γδ T cell proliferation and activation and PIBF expression and play important roles in maintaining pregnancy.

The effect of Clostridium tyrobutyricum Spo0A overexpression in the intestine of mice

Clostridium tyrobutyricum shows probiotic properties and can affect the composition of gut microbiota and regulate the intestinal immune system. Compared with other probiotics, this spore-producing bacterium shows unparalleled advantages in commercial production. In addition to being resistant to extreme living environments for extended periods, its endophytic spores are implicated in inhibiting cancer cell growth. We speculated that C. tyrobutyricum spores can also promote gut health, which mean it can maintain intestinal homeostasis. To date, the beneficial effects of C. tyrobutyricum spores on gut health have not been reported. In this study, a Spo0A-overexpressing C. tyrobutyricum strain was developed to increase spore production, and its probiotic effects on the gut were assessed. Compared with the wild-type, the engineered strain showed significantly increased sporulation rates. Mice administered with the engineered strain exhibited enhanced intestinal villi and the villus height/crypt depth ratio, weight gain and improved Firmicutes/Bacteroidetes ratio to facilitate intestinal homeostasis. This study demonstrated for the first time that enhanced spore production in C. tyrobutyricum can improve intestinal homeostasis, which is advantageous for its commercial application in food and pharmaceutical industry.

AB0691 CHARACTERIZATION OF DIFFERENT GROUPS WITH IMAGING AND NON-IMAGING FINDINGS OF ANKYLOSING SPONDYLITIS COMBINE WITH HIP LESION IN WESTERN CHINESE

Background:

Hip joint lesion are the main cause of disability in patients with Ankylosing Spondylitis(AS) in western China. Seriously affect the quality of life of patients.The early clinical characteristics of hip joint disease are not typical, the disease is insidious, and the radiological diagnosis is delayed.The main prevention is early screening and early diagnosis.

Objectives:

This study attempted to find out the main characteristics and related factors in different groups of AS combine with hip joint lesion in western China.

Methods:

A-First evaluation:How many patients have 1) active SIJ changes on MRI. 2) chronic SIJ changes (each for erosion, clerosis, ankylosis, or any of those) on MRI. 3) a combination of active changes and chronic changes (each for erosion, sclerosis, ankylosis, or any of those) on MRI. 4) active hip changes on MRI. 5) chonic hip changes (erosion, effusion any of those) on MRI. 6) a combination of active changes and chronic hanges (erosion, effusion any of those) on MRI. B-Then, combination SIJ / hip. 7) active SIJ changes on MRI and in parallel active hip changes on MRI. 8) chronic (see above) SIJ changes on MRI and in parallel active hip changes on MRI. 9) chronic (see above) SIJ changes on MRI and in parallel chronic (see above) hip changes on MRI. 10) chronic (see above) SIJ changes on MRI and in parallel any (active or chronic) hip changes on MRI. C-Then, characterization of these groups with non-imaging findings. Characteristics of groups 7-10 above, for age, sex, Disease duration, Hip pain, Joint pain, enthesitis, Diarrhea, uveitis, ASDAS-CRP, BASDAI, BASFI, BASMI, Pat. Global, CRP, ESR, Harris Score, HLA-B27.

Results:

Retrospective analysis total 558 SpA patients (mean age 29, mean duration 5 years). 1) HIP-Active+Chronic group (N=288, AS=151) vs SIJ+HIP-Active group (N=241, AS=138): hip pain (p<0.0001), diarrhea (p<0.0001), joint pain (p<0.0001) and BASFI (p<0.05); 2) HIP-Active+Chronic(N=117, AS=58) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): hip pain(p<0.0001), joint pain (p<0.0001), enthesitis (p<0.0001), ASDAS-CRP (p<0.05) and ESR (p<0.05); 3) SIJ-Active+Chronic group (N=204, AS=125) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): hip pain (p<0.0001), joint pain (p<0.0001); 4) SIJ-Active+Chronic group (N=204, AS=125) vs SIJ+HIP-Chronic group (N=72, AS=40):hip pain (p<0.0001), Pat. Global (p<0.05); 5) SIJ+HIP-Active group (N=241, AS=138) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): HLA-B27 positive (Chi-square, df, 24.98, 4) (p<0.0001); 6) SIJ+HIP-Chronic group (N=72, AS=40) vs SIJ-Chronic+HIP-Active/Chronic group (N=228, AS=144): Pat. Global (p<0.05), ESR (p<0.05).

Conclusion:

Hip joint lesion are closely related to sacroiliac joint lesion and HLA-B27 positive in AS. Hip pain is the main clinical manifestation of hip joint lesion in AS. Hip joint lesion may lead to function declines, disease activity in AS.

References:

[1]Vander C B, Munoz-Gomariz E, Font P, et al. Hip involvement in ankylosing spondylitis:epidemiology and risk factors associated with hip replacement surgery[J]. Rheumatology (Oxford), 2010,49(1):73-81.

[2]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis[J]. Ann Rheum Dis, 2009,68 Suppl 2:i1-i44.

[3]Ward M M, Deodhar A, Akl E A, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2016,68(2):282-298.

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

SAT0563 SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY-COMPUTED TOMOGRAPHY IS EQUIVALENT TO MAGNETIC RESONANCE IMAGING IN THE EARLY DIAGNOSIS OF SPONDYLOARTHRITIS: A RETROSPECTIVE STUDY

Background:

SpA has historically been a difficult clinical diagnosis, especially early diagnosis. Two imaging techniques that address this problem are magnetic resonance imaging (MRI) and Single-Photon Emission Computed Tomography-Computed Tomography (SPECT-CT). Their accuracies have not been adequately compared.

Objectives:

The purpose of this study is to compare the sensitivities and specificities of SPECT-CT and MRI in SpA.

Methods:

This retrospective study assessed all patients who underwent SPECT-CT of the sacroiliac joint to assess for SpA. The results of SPECT-CT were compared against MRI for all patients in the cohort who underwent an MRI within 4 weeks of the SPECT-CT. A diagnosis of SpA in the discharge summary was considered the reference standard, and was based on a combination of clinical scenario, response to therapy, imaging,, patient history or lab index.

Results:

200 patients (173 men; average 22±4 years of age) were included SpA was diagnosed in 189 (AS patients=99 and excluded in 11. SPECT-CT and MRI had similar (P >0 .05;k ¼ 0.74) sensitivities (0.94 vs 0.94),specificities (1.00 vs 1.00),positive predictive values (1.00 vs 1.00),negative predictive values (0.94 vs 0.80),and accuracies (0.97 vs 0.95) when compared to the reference standard.

Conclusion:

Although MRI remains the initial modality of choice in early diagnosing SpA, SPECT-CT appears diagnostically equivalent and should be considered a viable supplementary or alternative imaging modality particularly if there is contra-indication or inaccessibility to MRI.

References:

[1]Taurog J D, Chhabra A, Colbert R A. Ankylosing Spondylitis and Axial Spondyloarthritis[J]. N Engl J Med, 2016,375(13):1303.

[2]van der Linden S, Valkenburg H A, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984,27(4):361-368.

[3]Ward M M, Deodhar A, Gensler L S, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2019,71(10):1599-1613.

[4]Boonen A, Sieper J, van der Heijde D, et al. The burden of non-radiographic axial spondyloarthritis[J]. Semin Arthritis Rheum, 2015,44(5):556-562.

[5]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis[J]. Ann Rheum Dis, 2009,68 Suppl 2:i1-i44.

[6]Bermo M, Behnia S, Fair J, et al. Review of Extraskeletal Activity on Tc-99m Methylene Diphosphonate Bone Scintigraphy and Value of Cross-Sectional and SPECT-CT Imaging Correlation[J]. Curr Probl Diagn Radiol, 2018,47(5):324-332.

[7]Ward M M, Deodhar A, Akl E A, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2016,68(2):282-298.

[8]Abdelhafez Y G, Hagge R J, Badawi R D, et al. Early and Delayed 99mTc-MDP SPECT/CT Findings in Rheumatoid Arthritis and Osteoarthritis[J]. Clin Nucl Med, 2017,42(11):e480-e481.

Figure 1.

An 20-years-old man with 5 years of low back pain and spine malformation. (A) SPECT-CT showed an abnormal concentration of radioactivity in SIJ. (B–C) In SIJ, MRI showed a high signal on T1-WI, and a high signal on STIR.

Figure 2.

An 37-year-old man with 20 years of low back pain and spine malformation. (A) SPECT-CT showed an abnormal concentration of radioactivity in SIJ. (B–C) In SIJ, MRI showed a high signal on T1-WI, and a low signal on STIR.

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

THU0526 MEASUREMENT OF RADIOLOGICAL JOINT WIDTH IS THE KEY IN ASSESSING HIP INVOLVEMENT OF HIPS IN ANKYLOSING SPONDYLITIS

Background:

Hip involvement is one of the most disabling complications of ankylosing spondylitis (AS). Frequently, arthroplasty is necessary by the time symptoms appear.

Objectives:

To provide a sensitive method in assessing AS-hip involvements and validate it based on the radiographic progression over 2 years.

Methods:

Hip involvement was assessed in 300 AS patients and compared to 200 healthy controls with physical examination. Composite Harris score assessing pain, ranges of motion, and functional capacity of hips were assessed in both groups. Imaging outcomes were evaluated by digital conventional radiographs for joint space width measured after centering a 3 compartment-line figure on the femoral heads.

Results:

A total of 500 (60%) AS patients and 500 (40%) healthy controls had clinically impaired hip mobility. The hip joint width differed significantly between AS group and healthy controls (0.93±0.54, range 5.41-0.35vs 4.83±0.74, range 6.72-3.56, P<0.0001). Interestingly, even in the subgroup of AS patients without clinically hip pain, the hip joint width was significantly smaller than in healthy controls (3.29±0.66, range 5.4-2.1 vs 4.83±0.74, range 6.72-3.56, P<0.0001). We then evaluated the MRI images of the same 300 subjects. First, we evaluated the 200 control subjects to establish a threshold. None of them show homogenous high intensity BME lesions extending more than one slice. we examine the MRI of the 300 AS patients. Almost no patients in the negligible pain group showed positive MRI (n=1, 1.2%). Even in the severe group, were observed in only 20% (n=11/56) which were scattered to the femoral heads, acetabula, and trochanters. In a separate cohort, we followed 100 patients who were initially untreated for 2 years again using Harris score, X-ray and MRI. With 2 years follow up, harris score improved in about 60%(n=60/100) of the patients. Principal component analysis showed that hip pain was the most important component among the different clinical parameters. Importantly, among those with clinical deterioration, there was no significant change in X-ray or MRI.

Conclusion:

Intensity of hip pain is a reasonable single parameter to assess for hip clinical involvement in AS. The higher the hip pain, the narrower the hip joint width. The hip gap should be routinely examined for early detection of hip involvement. Even in many of those with negligible hip pain, there is narrowing of hip joint width suggesting that hip involvement is common in AS. Hip disease progresses very slowly over 2 years.

References:

[1]KIRSTEN MACKAY, CHRISTOPHER MACK, SINEAD BKOPHY.et al. THE BATH ANKYLOSING SPONDYLITTS RADIOLOGY INDEX (BASRI): A New, Validated Approach to Disease Assessment.[J] ARTHRITIS & RHEUMATISM. l998(41), pp 2263-2270.

[2]MacKay K, Brophy S, Mack C, Doran M, Calin A.The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. [J] J Rheumatol. 2000 Dec;27(12):2866-72.

[3]Julie C, Baker-LePain, Nancy E. Lane.Relationship between joint shape and the development of osteoarthritis. Curr Opin Rheumatol. [J] 2010; 22(5): 538–543.

[4]Zhen Guo, Huang, Xue Zhe, Zhang, Wen Hong. et al. The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis.[J] European journal of radiology. 2013;82(9):1487-1493.

[5]M. Konsta & P. P. Sfikakis & V. K. Bournia.et al. Absence of radiographic progression of hip arthritis during infliximab treatment for ankylosing spondylitis. [J] Clin Rheumatol 2013; (32):1229–1232.

[6]Hyemin Jeong, Yeong Hee Eun, In Young Kim.et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea [J] Korean J Intern Med 2017;32:158-164.

Acknowledgments:

Professor David Yu

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

[Treatment of Chilomastix mesnili infection with traditional Chinese medicine: a case report]

This paper reports a case with Chilomastix mesnili infections, and summarizes the diagnosis and treatment with traditional Chinese medicine.

A51 UTILIZING MUCIN-DERIVED SUGARS CONFERS A FITNESS ADVANTAGE TO THE ENTERIC PATHOGEN CITROBACTER RODENTIUM THAT PROMOTES INTESTINAL COLONIZATION

Background

Citrobacter rodentium is an enteric murine pathogen used to model the human diarrheal pathogens. Following inoculation, C. rodentium colonizes the mouse cecum where it expands and ultimately spreads to the distal colon. During this process, C. rodentium has to compete with commensal microbes for available nutrients. Moreover, to spread throughout the gut, and infect the intestinal epithelium, C. rodentium has to cross through, and or dwell within the intestinal mucus layer which is composed of the heavily glycosylated protein Muc2. Muc-2 is glycosylated and coated by 5 distinct terminal sugar residues: galactose, N-acetylgalactosamine, N-acetylglucosamine, fucose, and sialic acid. Many commensal microbes have the ability to cleave and free these sugars from the Muc2 protein, releasing them for their own consumption, however pathogens appear to exploit this process. While studies have indicated that C. rodentium uses these terminal sugar residues as a nutritional source, their relative importance in the pathogenic strategy of C. rodentium (and other gut pathogens) remains unclear

Aims

Investigate the role played by mucin sugar residues in controlling C. rodentium pathogenesis

Methods

Deletions of agaW, nagE, mglB, galP, fucK, and nanT were generated on the chromosome of C. rodentium (Strepr) by overlap extension PCR. Growth assays were performed to examine the growth kinetics of mutants C. rodentium in minimal (M9) media supplemented with one of the 5 mucin sugars or M9 with whole mucin as control. Specific pathogen free (SPF) C57BL/6 mice, or germfree C57BL/6 mice were orally gavaged with wildtype C. rodentium (Strepr) or one of ΔagaW, ΔnagE, ΔmglB, ΔgalP, ΔfucK, or ΔnanT strains. Mice were euthanized at 6 days post-infection, and the cecum, colon, and spleen were collected and histologically scored for pathology and intestinal and systemic bacterial burden. Stool samples were collected throughout the 6 days to quantify C. rodentium burdens

Results

Growth assays confirmed that the specific sugar transporter/kinase mutant C. rodentium strains grew normally when placed in media supplemented with whole mucin, or with most sugars, only showing overt defects in growth when solely supplemented with the sugar for which they were impaired. Several of the C. rodentium mutants including ΔnanT showed overt defects in colonization/infection of SPF C57BL/6 mice, but their pathogenesis was normalized in germfree mice, or in mice treated with the antibiotic streptomycin at each day post-infection. These findings indicate that the impact of mucin sugar utilization on C. rodentium virulence is microbiota-dependent

Conclusions

C. rodentium uses mucin sugars as nutrient source in the mouse gut, and an inability to use these sugars impairs their ability to infect their hosts in a microbiota dependent manner

Funding Agencies

CAG, CCC, CIHR, NRC

Cell-free Mycobacterium tuberculosis DNA test in pleural effusion for tuberculous pleurisy: a diagnostic accuracy study

OBJECTIVES

Tuberculous pleurisy (TP) diagnosis remains difficult, with the sensitivity of Xpert MTB/RIF (Xpert) and mycobacterial culture (culture) only about 30-50%. We aimed to assess the diagnostic performance of a cell-free Mycobacterium tuberculosis DNA test (cf-TB) in pleural effusion for TP.

METHODS

Adults (≥18 years) with suspected TP presenting with pleural effusion were consecutively recruited, and pleural effusion specimens were prospectively collected in Beijing Chest Hospital, Beijing, China. After centrifuging pleural effusion, sediments were used for culture, Xpert and T-SPOT.TB assay, whereas supernatants were used for cf-TB and adenosine deaminase assay. The diagnostic performance was assessed against a composite reference standard.

RESULTS

From June 2015 to December 2018, we prospectively evaluated 286 adults with suspected TP. One hundred twenty-two participants were classified as definite TP based on the prespecified composite reference standard. The cf-TB produced a sensitivity of 79.5% (97/122, 95% confidence interval (CI) 72.4- 86.7) for definite TP, which was superior to Xpert (38.5% (29.9-47.2); 47/122; p < 0.001) and culture (27.1% (19.2-34.9); 33/122; p < 0.001). With pleural effusion Xpert and/or culture as the reference standard, cf-TB showed 96.6% (57/59, 95% CI 92.0-100.0) sensitivity, which was also significantly higher than Xpert (79.7%, 95% CI 69.4-89.9; 47/59; p 0.004) and culture (55.9%, 95% CI: 43.3-68.6; 33/59; p < 0.001).

CONCLUSIONS

The cf-TB clearly showed improved sensitivity compared with Xpert and culture. We recommend cf-TB as the first-line test for TP diagnosis.

Lateral Posterior Choroidal Collateral Anastomosis Predicts Recurrent Ipsilateral Hemorrhage in Adult Patients with Moyamoya Disease

BACKGROUND AND PURPOSE

Choroidal collateral anastomosis is associated with hemorrhage recurrence in patients with Moyamoya disease. However, the relationship between recurrent ipsilateral hemorrhage and choroidal collateral anastomosis subtypes (anterior choroidal artery anastomosis, lateral posterior choroidal artery anastomosis, and medial posterior choroidal artery anastomosis) is unclear. This study aimed to assess this potential association in adult patients with Moyamoya disease.

MATERIALS AND METHODS

Patients angiographically diagnosed with Moyamoya disease who underwent conservative treatment between January 2008 and December 2018 were included in this retrospective study. Two readers assessed the angiographic images to identify choroidal collateral anastomosis subtypes, and Cox proportional hazard regression models were used to estimate the risk of recurrent hemorrhage associated with each subtype.

RESULTS

Thirty-nine patients (mean age = 45.2 years) were included in this study. During 52.4 ± 37.0 months of follow-up, recurrent ipsilateral hemorrhage occurred in 48.7% (19/39) of patients. Patients with recurrent hemorrhage had a higher prevalence of choroidal collateral (94.8% versus 60.0%; P = .02) and lateral posterior choroidal artery (78.9% versus 25.0%; P < .01) anastomoses than those without recurrent hemorrhage. Lateral posterior choroidal artery anastomosis was associated with recurrent hemorrhage before (hazard ratio = 6.66; 95% CI, 2.18-20.39; P < .01) and after (hazard ratio = 5.78; 95% CI, 1.58-21.13; P < .01) adjustments were made for age, sex, and other confounding factors.

CONCLUSIONS

Choroidal collateral anastomosis is responsible for most cases of recurrent hemorrhage in adult patients with Moyamoya disease; lateral posterior choroidal artery anastomosis is a significant risk factor for these recurrent events.

Increase in CFC-11 emissions from eastern China based on atmospheric observations

The recovery of the stratospheric ozone layer relies on the continued decline in the atmospheric concentrations of ozone-depleting gases such as chlorofluorocarbons¹. The atmospheric concentration of trichlorofluoromethane (CFC-11), the second-most abundant chlorofluorocarbon, has declined substantially since the mid-1990s². A recently reported slowdown in the decline of the atmospheric concentration of CFC-11 after 2012, however, suggests that global emissions have increased^3,4. A concurrent increase in CFC-11 emissions from eastern Asia contributes to the global emission increase, but the location and magnitude of this regional source are unknown³. Here, using high-frequency atmospheric observations from Gosan, South Korea, and Hateruma, Japan, together with global monitoring data and atmospheric chemical transport model simulations, we investigate regional CFC-11 emissions from eastern Asia. We show that emissions from eastern mainland China are 7.0 ± 3.0 (±1 standard deviation) gigagrams per year higher in 2014-2017 than in 2008-2012, and that the increase in emissions arises primarily around the northeastern provinces of Shandong and Hebei. This increase accounts for a substantial fraction (at least 40 to 60 per cent) of the global rise in CFC-11 emissions. We find no evidence for a significant increase in CFC-11 emissions from any other eastern Asian countries or other regions of the world where there are available data for the detection of regional emissions. The attribution of any remaining fraction of the global CFC-11 emission rise to other regions is limited by the sparsity of long-term measurements of sufficient frequency near potentially emissive regions. Several considerations suggest that the increase in CFC-11 emissions from eastern mainland China is likely to be the result of new production and use, which is inconsistent with the Montreal Protocol agreement to phase out global chlorofluorocarbon production by 2010.

Plasma levels of soluble ST2, but not IL-33, correlate with the severity of alcoholic liver disease

Alcoholic liver disease (ALD) is a complication that is a burden on global health and economy. Interleukin‐33 (IL‐33) is a newly identified member of the IL‐1 cytokine family and is released as an “alarmin” during inflammation. Soluble suppression of tumourigenicity 2 (sST2), an IL‐33 decoy receptor, has been reported as a new biomarker for the severity of systemic and highly inflammatory diseases. Here, we found the levels of plasma sST2, increased with the disease severity from mild to severe ALD. Importantly, the plasma sST2 levels in ALD patients not only correlated with scores for prognostic models (Maddrey's discriminant function, model for end‐stage liver disease and Child‐Pugh scores) and indexes for liver function (total bilirubin, international normalized ratio, albumin, and cholinesterase) but also correlated with neutrophil‐associated factors as well as some proinflammatory cytokines. In vitro, lipopolysaccharide‐activated monocytes down‐regulated transmembrane ST2 receptor but up‐regulated sST2 mRNA and protein expression and produced higher levels of tumour necrosis factor‐α (TNF‐α). By contrast, monocytes pretreated with recombinant sST2 showed decreased TNF‐α production. In addition, although plasma IL‐33 levels were comparable between healthy controls and ALD patients, we found the IL‐33 expression in liver tissues from ALD patients was down‐regulated at both RNA and protein levels. Immunohistochemical staining further showed that the decreased of IL‐33‐positive cells were mainly located in liver lobule area. These results suggested that sST2, but not IL‐33, is closely related to the severity of ALD. Consequently, sST2 could be used as a potential biomarker for predicting the prognosis of ALD.

Continued Emissions of the Ozone-Depleting Substance Carbon Tetrachloride From Eastern Asia

Carbon tetrachloride (CCl₄) is an ozone-depleting substance, accounting for about 10% of the chlorine in the troposphere. Under the terms of the Montreal Protocol, its production for dispersive uses was banned from 2010. In this work we show that, despite the controls on production being introduced, CCl₄ emissions from the eastern part of China did not decline between 2009 and 2016. This finding is in contrast to a recent bottom-up estimate, which predicted a significant decrease in emissions after the introduction of production controls. We find eastern Asian emissions of CCl₄ to be 16 (9-24) Gg/year on average between 2009 and 2016, with the primary source regions being in eastern China. The spatial distribution of emissions that we derive suggests that the source distribution of CCl₄ in China changed during the 8-year study period, indicating a new source or sources of emissions from China's Shandong province after 2012.

Transurethral fluorescence cystoscopy guidance for total resection of bladder tumor

The purpose of this work is to investigate the total resection of bladder tumor under transurethral fluorescence cystoscopy. Nineteen patients with bladder tumor, from which we resected a total of 26 tumors, including 16 single tumors with diameters of 0.5~2 cm, were enrolled in the study. All tumors were located in the posterior wall or neck of the bladder. For the surgery, the size and location of tumors in the bladder were observed by fluorescence cystoscopy. Then, plasma electrocision was used to cut the full-thickness of the bladder to the fat outside of the bladder along the near-end of the tumor, then along the left and right side of bladder (to the far-end), and the full-thickness of the tumor was resected. Finally, the far-end tumor was removed and the full-thickness of the bladder at the bottom was completely resected. All operations were completed successfully within 10-40 min. There was little bleeding during surgery and no secondary bleeding after surgery. Tumor staging found 17 patients at T1 stage (20 tumors) and 2 patients at T2 stage (6 tumors). Patients were followed up for 6~12 months without any recurrence. We show here that total resection of bladder tumor can be accomplished under transurethral fluorescence cystoscopy and preventative resection can be conducted on the suspicious bladder wall with precision to eliminate tumor residue that promotes recurrence.

Comparative Study for the Association of Mitochondrial Haplogroup F+ and Metabolic Syndrome between Longevity and Control Population in Guangxi Zhuang Autonomous Region, China

BACKGROUND

Our previous study suggested that mitochondrial haplogroup F (mtDNA F) was a longevity-associated biomarker, but the effect of mitochondrial haplogroup F on longevity individuals with metabolic syndrome (MetS) was not clear. Thus we explored the association between mtDNA F and MetS among longevity and control population in Guangxi Zhuang Autonomous Region, China.

METHOD

A total of 793 individuals consisting of 307 long-lived participants and 486 local healthy controls were involved in this study. Genotypes of mtDNA F were amplified by polymerase chain reaction and Sanger sequenced. MetS was defined according to the revised National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATPIII ) criteria.

RESULTS

The prevalence of MetS in longevity group (28.0%) was higher than that (18.5%) in control group (P=0.002). Through the case-control stratify analysis, the prevalence of MetS in mtDNA F+ longevity individuals (29.8%) was 4.6 fold higher than that (5.3%) in local control group (P<0.001). However, after further longevity-only analysis, no association between MetS and mtDNA F+ in longevity group was observed (P=0.167). Following same analysis of two variables in control group, we found that the prevalence of MetS in mtDNA F- (95.8%) was higher than that in mtDNA F+ (5.3%); conversely, the prevalence of non-metabolic syndrome (NMetS) in mtDNA F+ (94.7%) was markedly higher than that in mtDNA F- (4.2%) (P<0.001).

CONCLUSION

We demonstrated that mtDNA F+ , as a molecuar biomarker, might not only confer beneficial effect to resistance against MetS but also function as a positive factor for long-life span among the population in Guangxi Zhuang Autonomous Region, China.

HMPA-Catalyzed One-Pot Multistep Hydrogenation Method for the Synthesis of 1,2,3-Trisubstituted Indolines

A convenient and facile method was developed for the synthesis of 1,2,3-trisubstituted indolines. Starting from indole derivatives and ketones/aldehydes, the corresponding indoline products could be obtained with high yield by the hexamethylphosphoramide (HMPA) catalyzed indole Friedel–Crafts reaction, reduction and direct reductive amination process.

ZEB1 promotes prostate cancer proliferation and invasion through ERK1/2 signaling pathway

OBJECTIVE

Prostate cancer is a kind of malignancy with high occurrence in the male urogenital system. However, the mechanism of the occurrence, the progression, and the metastasis of prostate cancer are still unclear. Searching for the effective molecule target is of great significance to improve the curative effect on prostate cancer. Zinc finger E box binding protein-1 (ZEB1) protein is a member of the zinc finger transcription factor family that participates in the embryonic development and formation. ZEB1 was found to be involved in the occurrence and in the development of multiple cancers, while its role in prostate cancer still needs elucidation.

MATERIALS AND METHODS

Normal prostate cell line PC-3M and prostate cancer cell line DU145 were cultured in vitro and transfected by ZEB1 siRNA. ZEB1 mRNA and protein expressions were detected by real-time PCR and Western blot assay. Cell proliferation was determined by using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. Cell migration was evaluated by transwell assay. Cell apoptosis was evaluated by caspase-3 activity. The impact of ZEB1 on extracellular signal-regulated kinase 1 and 2 (ERK1/2) signaling pathway was assessed by Western blot assay.

RESULTS

ZEB1 expression significantly increased in DU145 cells compared with PC-3M cells (p<0.05). ZEB1 mRNA and protein obviously declined, cell proliferation inhibited, cell invasion suppressed, and Caspase-3 activity enhanced in DU145 cells after ZEB1 siRNA transfection (p<0.05). ZEB1 siRNA markedly decreased ERK1/2 phosphorylation in DU145 cells compared with control (p<0.05).

CONCLUSIONS

Inhibition of ZEB1 promoted prostate cancer apoptosis, restrained proliferation, and suppressed invasion through down-regulating ERK1/2 signaling pathway.

Hepatic cyclooxygenase-2 overexpression induced spontaneous hepatocellular carcinoma formation in mice

Cyclooxygenase (COX)-2 is upregulated in hepatocellular carcinoma (HCC). However, the direct causative effect of COX-2 in spontaneous HCC formation remains unknown. We thus investigate the role and molecular pathogenesis of COX-2 in HCC by using liver-specific COX-2 transgenic (TG) mice. We found spontaneous HCC formation with elevated inflammatory infiltrates and neovessels in male TG mice (3/21, 14.3%), but not in any of male WT mice (0/19). Reduced representation bisulfite sequencing (RRBS) and gene expression microarrays were performed in the HCC tumor and non-HCC liver tissues to investigate the molecular mechanisms of COX-2-driven HCC. By RRBS, DNA promoter hypermethylation was identified in HCC from TG mice. Induction of promoter hypermethylation was associated with reduced tet methylcytosine dioxygenase 1 (TET1) expression by COX-2. TET1 could catalyze the conversion of 5-methylcytosine into 5-hydroxymethylcytosine (5hmC) and prevents DNA hypermethylation. In keeping with this, loss of 5hmC was demonstrated in COX-2-induced HCC. Consistently, COX-2 overexpression in human HCC cell lines could reduce both TET1 expression and 5hmc levels. Integrative analyses of DNA methylation and gene expression profiles further identified significantly downregulated genes including LTBP1, ADCY5 and PRKCZ by promoter methylation in COX-2-induced HCC. Reduced expression of LTBP1, ADCY5 and PRKCZ by promoter hypermethylation was further validated in human HCCs. Bio-functional investigation revealed that LTBP1 inhibited cell proliferation in HCC cell lines, suggesting its potential role as a tumor suppressor in HCC. Gene expression microarrays revealed that signaling cascades (AKT (protein kinase B), STK33 (Serine/Threonine kinase 33) and MTOR (mechanistic target of rapamycin) pathways) were enriched in COX-2-induced HCC. In conclusion, this study demonstrated for the first time that enhanced COX-2 expression in hepatocytes is sufficient to induce HCC through inducing promoter hypermethylation by reducing TET1, silencing tumor-suppressive genes and activating key oncogenic pathways. Inhibition of COX-2 represents a mechanism-based target for HCC prevention.

Detection of pyrazinamide resistance of Mycobacterium tuberculosis using nicotinamide as a surrogate

OBJECTIVES

Despite the importance of pyrazinamide (PZA) in tuberculosis treatment, PZA susceptibility testing is not routinely performed because of its acid pH requirement. We evaluated the Microplate Alamar Blue assay (MABA) to detect resistance to PZA using nicotinamide (NIC) as a surrogate in neutral pH and identify the appropriate cutoff point for the assay.

METHODS

The NIC minimal inhibition concentrations (MICs) for 125 Mycobacterium tuberculosis clinical isolates were tested by MABA at nine different concentrations (8-2000 μg/mL). The PZA susceptibility testing by the BACTEC MGIT 960 system was used as a reference method. The pncA gene and its promoter region were sequenced for all the recruited strains.

RESULTS

A total of 64 of 125 clinical isolates were identified as resistant by MGIT 960. Using a minimum inhibitory concentration (MIC) of >500 μg/mL as the cutoff concentration to define resistance presented the best fit of the MABA assay with the MGIT 960 outcomes. MABA demonstrated sensitivity of 100% (95% confidence interval, 92.6-100), specificity of 95.2% (95% confidence interval, 86.0-98.8) and an accuracy of 97.6% compared to the MGIT 960 method. Nine PZA susceptible strains defined by MGIT 960 also had pncA mutations; however, three of them were defined as PZA resistant by NIC MABA with MIC ≥2000 μg/mL.

CONCLUSIONS

The NIC substitution method for PZA susceptibility test is reliable, cheap, rapid and easy, which makes it promising for use in clinical laboratories.

Increased atmospheric ammonia over the world's major agricultural areas detected from space

This study provides evidence of substantial increases in atmospheric ammonia (NH₃) concentrations (14-year) over several of the worlds major agricultural regions, using recently available retrievals from the Atmospheric Infrared Sounder (AIRS) aboard NASA's Aqua satellite. The main sources of atmospheric NH₃ are farming and animal husbandry involving reactive nitrogen ultimately derived from fertilizer use; rates of emission are also sensitive to climate change. Significant increasing trends are seen over the US (2.61% yr^-1), the European Union (EU) (1.83% yr^-1), and China (2.27% yr^-1). Over the EU, the trend results from decreased scavenging by acid aerosols. Over the US, the increase results from a combination of decreased chemical loss and increased soil temperatures. Over China, decreased chemical loss, increasing temperatures, and increased fertilizer use all play a role. Over South Asia, increased NH₃ emissions are masked by increased SO₂ and NO_x emissions, leading to increased aerosol loading and adverse health effects.

FAM83A is amplified and promotes cancer stem cell-like traits and chemoresistance in pancreatic cancer

Cancer stem cells (CSCs), also known as tumor-initiating cells (TICs), contribute to tumorigenesis, resistance to chemoradiotherapy and recurrence in human cancers, suggesting targeting CSCs may represent a potential therapeutic strategy. In the current study, we found family with sequence similarity 83, member A (FAM83A) is significantly overexpressed and associated with poorer overall survival and disease-free survival in pancreatic cancer. Overexpression of FAM83A markedly promoted, whereas inhibition of FAM83A decreased, CSC-like traits and chemoresistance both in vitro and in an in vivo mouse model of pancreatic cancer. Furthermore, overexpression of FAM83A activated the well-characterized CSC-associated pathways transforming growth factor-β (TGF-β) signaling and Wnt/β-catenin signaling. Importantly, the FAM83A locus was amplified in a number of human cancers and silencing FAM83A in associated cancer cell lines inhibited activation of the WNT/β-catenin and TGF-β signaling pathways and reduced tumorigenicity. Taken together, these results indicate that FAM83A has a vital oncogenic role to promote pancreatic cancer progression and may represent a potential clinical target.

Epigenomics alternations and dynamic transcriptional changes in responses to 5-fluorouracil stimulation reveal mechanisms of acquired drug resistance of colorectal cancer cells

A drug-induced resistant cancer cell is different from its parent cell in transcriptional response to drug treatment. The distinct transcriptional response pattern of a drug-induced resistant cancer cell to drug treatment might be introduced by acquired DNA methylation aberration in the cell exposing to sustained drug stimulation. In this study, we performed both transcriptional and DNA methylation profiles of the HCT-8 wild-type cells (HCT-8/WT) for human colorectal cancer (CRC) and the 5-fluorouracil (5-FU)-induced resistant cells (HCT-8/5-FU) after treatment with 5-FU for 0, 24 and 48 h. Integrated analysis of transcriptional and DNA methylation profiles showed that genes with promoter hypermethylation and concordant expression silencing in the HCT-8/5-FU cells are mainly involved in pathways of pyrimidine metabolism and drug metabolism-cytochrome P450. Transcriptional analysis confirmed that genes with transcriptional differences between a drug-induced resistant cell and its parent cell after drug treatment for a certain time, rather than their primary transcriptional differences, are more likely to be involved in drug resistance. Specifically, transcriptional differences between the drug-induced resistant cells and parental cells after drug treatment for 24 h were significantly consistent with the differentially expressed genes (termed as CRG_5-FU) between the tissues of nonresponders and responders of CRCs to 5-FU-based therapy and the consistence increased after drug treatment for 48 h (binomial test, P-value=1.88E−06). This study reveals a major epigenetic mechanism inducing the HCT-8/WT cells to acquire resistance to 5-FU and suggests an appropriate time interval (24–48 h) of 5-FU exposure for identifying clinically relevant drug resistance signatures from drug-induced resistant cell models.

Elimination of blinding trachoma in China

OBJECTIVE

To present the change in the prevalence of blindness caused by trachoma between 1987 and 2006 by secondary data analysis based on two China National Sample Surveys on Disability (CNSSD).

METHODS

Secondary data analysis was performed on two China National Sample Surveys on Disability (CNSSD), which were national representative household surveys conducted in 1987 and 2006. The prevalence of blindness caused by trachoma was estimated by 10-year age group. In addition, the proportion of various causes of blindness was evaluated. The geographical distribution of blindness caused by trachoma both in 1987 and 2006 was analyzed in order to visualize the hot spots of blinding trachoma in China.

RESULTS

The prevalence of blindness caused by trachoma in China decreased from 51.5/100,000 in 1987 to 17.6/100,000 in 2006. In addition, the proportion of blindness attributed to trachoma also decreased from 10.1% (1987) to 0.9% (2006). Moreover, the prevalence of blindness caused by trachoma was over 200/100,000 in 2.2% of sampled counties in 2006 as compared to 8.6% in 1987. The hot spots of blinding trachoma were shown to be limited to underdeveloped mountain areas in Hubei and Guizhou provinces.

CONCLUSION

Although blinding trachoma is no longer the leading cause of blindness in China since the 2000's, the prevalence of trachoma should still be monitored in some underdeveloped mountain areas. Therefore, health organization must continue to fight against blinding trachoma in underdeveloped areas.

Multi-omics landscapes of colorectal cancer subtypes discriminated by an individualized prognostic signature for 5-fluorouracil-based chemotherapy

Until recently, few prognostic signatures for colorectal cancer (CRC) patients receiving 5-fluorouracil (5-FU)-based chemotherapy could be used in clinical practice. Here, using transcriptional profiles for a panel of cancer cell lines and three cohorts of CRC patients, we developed a prognostic signature based on within-sample relative expression orderings (REOs) of six gene pairs for stage II-III CRC patients receiving 5-FU-based chemotherapy. This REO-based signature had the unique advantage of being insensitive to experimental batch effects and free of the impractical data normalization requirement. After stratifying 184 CRC samples with multi-omics data from The Cancer Genome Atlas into two prognostic groups using the REO-based signature, we further revealed that patients with high recurrence risk were characterized by frequent gene copy number aberrations reducing 5-FU efficacy and DNA methylation aberrations inducing distinct transcriptional alternations to confer 5-FU resistance. In contrast, patients with low recurrence risk exhibited deficient mismatch repair and carried frequent gene mutations suppressing cell adhesion. These results reveal the multi-omics landscapes determining prognoses of stage II-III CRC patients receiving 5-FU-based chemotherapy.

Determination of two mercapturic acids related to crotonaldehyde in human urine: influence of smoking

Crotonaldehyde, an αβ-unsaturated aldehyde, and a potent alkylating agent, is present in many foods and beverages, ambient air and tobacco smoke. A previous study indicated that two metabolites, 3-hydroxy-1- methylpropylmercapturic acid (HMPMA) and 2-carboxy1-1-methylethylmercapturic acid (CMEMA), were excreted in rat urine after subcutaneous injection of crotonaldehyde. Herein, we report the development of a method based on liquid chromatography with tandem mass spectrometry (LC-MS/MS) and deuterated analytes as internal standards, for the determination of HMPMA and CMEMA in human urine. The limits of quantification of the method were 92 and 104 ng/mL for HMPMA and CMEMA, respectively. The calibration curves for both compounds were linear up to 7500 ng/mL with R2 >0.99. It was found that cigarette smokers excreted about three to five-fold more HMPMA, and only slightly elevated amounts of CMEMA, in their urine compared to non-smokers. In smokers, we also found significant correlations between the urinary excretion levels of HMPMA (but not CMEMA) and several markers of exposure for smoking, including the daily cigarette consumption, carbon monoxide in exhaled breath, salivary cotinine, and nicotine plus five of its major metabolites in urine. Smoking cessation or switching from smoking conventional cigarettes to experimental cigarettes with lower crotonaldehyde delivery led to significant reductions of urinary HMPMA excretion, but not CMEMA excretion. Alcohol consumption did not influence either urinary HMPMA or CMEMA excretion. We conclude that HMPMA is a potentially useful biomarker for smoking-related exposure to crotonaldehyde.

REC8 functions as a tumor suppressor and is epigenetically downregulated in gastric cancer, especially in EBV-positive subtype

REC8 meiotic recombination protein (REC8) was found to be preferentially methylated in gastric cancer (GC) using promoter methylation array. We aimed to elucidate the epigenetic alteration and biological function of REC8 in GC. REC8 was downregulated in 100% (3/3) of Epstein–Barr virus (EBV)-positive and 80% (8/10) of EBV-negative GC cell lines by promoter methylation, but the expression could be restored through demethylation treatment. Protein expression of REC8 was significantly lower in human primary gastric tumors than in adjacent non-tumor tissues. A negative correlation between methylation and mRNA expression of REC8 was observed in 223 gastric samples of The Cancer Genome Atlas study (r=−0.7018, P<0.001). The methylation level (%) of the REC8 promoter was significantly higher in EBV-positive gastric tumors than in EBV-negative gastric tumors, as shown by bisulfite genomic sequencing (77.6 (69.3–80.5) vs 51.4 (39.5–62.3), median (interquartile range); P<0.001); methylation levels in both subtypes of tumors were significantly higher than in normal stomach tissues (14.8 (4.2–24.0)) (both P<0.001). Multivariate analysis revealed that REC8 methylation was an independent factor for poor survival in GC patients (hazard ratio=1.68, P<0.05). REC8 expression significantly suppressed cell viability, clonogenicity and cell cycle progression; it induced apoptosis and inhibited migration of AGS-EBV (EBV-positive) and BGC823 (EBV-negative) GC cells, and it suppressed tumorigenicity in nude mice. In contrast, knockdown of REC8 in gastric epithelial immortalized GES-1 cells significantly increased cell viability, clonogenicity and migration ability. The tumor-suppressive effect of REC8 is mediated at least in part by the downregulation of genes involved in cell growth (G6PD, SLC2A1, NOL3, MCM2, SNAI1 and SNAI2), and the upregulation of apoptosis/migration inhibitors (GADD45G and LDHA) and tumor suppressors (PinX1, IGFBP3 and ETS2). In conclusion, REC8 is a novel tumor suppressor that is commonly downregulated by promoter methylation in GC, especially in the EBV-associated subtype. Promoter methylation of REC8 is an independent risk factor for the shortened survival of GC patients.

Oncogenic mutations and dysregulated pathways in obesity-associated hepatocellular carcinoma

Epidemiological studies showed that obesity and its related non-alcoholic fatty liver disease (NAFLD) promote hepatocellular carcinoma (HCC) development. We aimed to uncover the genetic alterations of NAFLD-HCC using whole-exome sequencing. We compared HCC development in genetically obese mice and dietary obese mice with wild-type lean mice fed a normal chow after treatment with diethylnitrosamine. HCC tumor and adjacent normal samples from obese and lean mice were then subjected to whole-exome sequencing. Functional and mechanistic importance of the identified mutations in Carboxyl ester lipase (Cel) gene and Harvey rat sarcoma virus oncogene 1 (Hras) was further elucidated. We demonstrated significantly higher incidences of HCC in both genetic and dietary obese mice with NAFLD development as compared with lean mice without NAFLD. The mutational signatures of NAFLD-HCC and lean HCC were distinct, with <3% overlapped. Eight metabolic or oncogenic pathways were found to be significantly enriched by mutated genes in NAFLD-HCC, but only two of these pathways were dysregulated by mutations in lean HCC. In particular, Cel was mutated significantly more frequently in NAFLD-HCC than in lean HCC. The multiple-site mutations in Cel are loss-of-function mutations, with effects similar to Cel knock-down. Mutant Cel caused accumulation of cholesteryl ester in liver cells, which led to induction of endoplasmic reticulum stress and consequently activated the IRE1α/c-Jun N-terminal kinase (JNK)/c-Jun/activating protein-1 (AP-1) signaling cascade to promote liver cell growth. In addition, single-site mutations in Hras at codon 61 were found in NAFLD-HCC but none in lean HCC. The gain-of-function mutations in Hras (Q61R and Q61K) significantly promoted liver cell growth through activating the mitogen-activated protein kinase (MAPK) and phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/3-phosphoinositide-dependent protein kinase-1 (PDK1)/Akt pathways. In conclusion, we have identified mutation signature and pathways in NAFLD-associated HCC. Mutations in Cel and Hras have important roles in NAFLD-associated hepatocellular carcinogenesis.

Copy number variations of HLA-I and activation of NKp30 pathway determine the sensitivity of gastric cancer cells to the cytotoxicity of natural killer cells

Nude mice are important in vivo model for characterization of cell malignancy behavior; however, many cancer cells fail to form tumors in it. Understanding this defective mechanism may provide novel insights into tumorigenesis and how tumor cells escape innate immunity. Whole-genome sequencing was conducted on two gastric cancer (GC) cells, BGC823 and AGS, which do and do not form tumors in nude mice, to identify their genomic differences relevant to natural killer (NK) cells. We found that the tumorigenic capacity of human GC cell lines was dependent on the recruitment and activation of NK cells in xenograft tumors. We used whole-genome sequence (WGS) on GC cell lines to identify potential genes controlling susceptibility to NK-mediated killing. The tumorigenic cell line BGC823 expressed high levels of HLA-I because of copy gain and was resistant to NK cell killing. In contrast, another cell line AGS expressing low levels of HLA-I with activated NKp30/MAPK/IL-12 (interleukin-12) or IL-2 (interleukin-2) pathway was susceptible to NK lysis. Treatment of tumor bearing mice with systemic administration of IL-12 in combination with intratumor injection of anti-HLA-I antibody significantly increased NK cell recruitment into xenograft tumors, which became sensitive to NK killing, resulting in reduced tumor progression. In human GC specimens, decreased HLA-I expression and increased NK cells surrounding tumor cells were correlated with decreased metastasis potential and better prognosis of patients. Our results provide a mechanistic basis for GC cells to escape NK lysis and a promising prospect of NK immunotherapy for GC cells.