[Association between hair trace element and all-cause death in elderly people in Hainan]

Objective: To explore the association between hair trace element and all-cause death in the elderly in Hainan Province. Methods: The subjects of the study were elderly people from China Hainan Centenarian Cohort Study, a total of 163 elderly were included. The association between hair trace element level and all-cause death was analyzed by using Cox proportional risk regression model. Results: After fully adjusting the covariates, the multiple Cox proportional hazards regression analyses showed that selenium (Se), manganese (Mn), strontium (Sr) concentrations in hair were significantly associated with all-cause mortality, the hazard ratio (HR) were 0.72 (95%CI: 0.54-0.98, P=0.035), 1.50 (95%CI: 1.07-2.11, P=0.020) and 0.54 (95%CI: 0.37-0.79, P=0.001), respectively. Subgroup and cross analysis showed that hair copper (Cu) were significant association with death in the people with anemia, the HR were 1.81 (95%CI: 1.13-2.88, P=0.013). And, hair Mn interacted with anemia, the HR was 0.46 (95%CI: 0.22-0.94, P=0.033). Conclusions: Se, Mn and Sr concentrations in hair were associated with the elevated risk for all-cause death in the elderly in Hainan. Se, Mn and Sr concentrations in hair can be used as a reference index for the prediction of the death risk of long-lived elderly in community, suggesting that the daily diet of elderly people are rich and diverse, in order to maintain normal and balanced trace element content in the body.

[Effect of recombinant human thrombin for hemostasis in liver resection: a randomized controlled phase Ⅲ clinical trial]

Objective: To evaluate the hemostatic efficacy, safety and immunogenicity of recombinant human thrombin in the treatment of liver wounds that still ooze after conventional surgical hemostasis. Methods: A multicenter, stratified randomized, double-blind, placebo-controlled phase Ⅲ trial with a planned enrollment of 510 subjects at 33 centers, with a 2∶1 randomization to the thrombin group versus the placebo group. An interim analysis will be conducted after approximately 70% of the subjects have completed the observation period. The primary efficacy endpoint was the rate of hemostasis within 6 minutes at the point of bleeding that could be evaluated. Safety analysis was performed one month after surgery, and the positive rates of anti-drug antibody (ADA) and neutralizing antibody were evaluated. Results: At the interim analysis, a total of 348 subjects had been randomized and received the study drug (215 were male and 133 were female). They were aged 19-69 (52.9±10.9)years. Among them, 232 were in the thrombin group and 116 were in the placebo group, with balanced and comparable demographics and baseline characteristics between the two groups. The hemostasis rate at 6 minutes was 71.6% (95%CI:65.75%-77.36%) in the thrombin group and 44.0% (95%CI: 34.93%-53.00%) in the placebo group, respectively (P<0.001). No grade≥3 drug-related adverse events and no drug-related deaths were reported from the study.No recombinant human thrombin-induced immunologically-enhanced ADA or immunologically-induced ADA was detected after topical use in subjects. Conclusion: Recombinant human thrombin has shown significant hemostatic efficacy and good safety in controlling bleeding during liver resection surgery, while also demonstrating low immunogenicity characteristics.

[Investigation and analysis of clinical application of stainless steel crowns for primary molars in 2013 and 2022]

Objective: To provide references for the clinical popularization of stainless steel crowns by analyzing the clinical application and affecting factors of stainless steel crowns used in primary molars based on a questionnaire survey. Methods: Pediatric dentists from all over the country in June to December 2013 and June to December 2022 were selected to answer the survey questionnaire through the online or offline methods for analyzing the clinical application and influencing factors of stainless steel crowns used in primary molars. Results: A total of 712 and 580 questionnaires were distributed, and 608 and 512 valid questionnaires were recovered respectively in 2013 and 2022. The effective rates of the questionnaires were 85.4% and 88.3%. Among them, the usage rates of stainless steel crowns in 2013 and 2022 were 52.6% (320/608) and 78.1% (400/512) respectively, with a statistically significant difference (χ2=78.68, P<0.001). The main reasons for not selecting stainless steel crowns in 2013 were high technical sensitivity [52.8% (152/288)], followed by the impact of crown edge on gingiva [50.0% (144/288)] and poor aesthetics [27.8% (80/288)], while in 2022 were the inadequate equipage in hospitals [53.6% (60/112)] and poor aesthetics [21.4% (24/112)]. The main reasons for choosing stainless steel crowns restoration were good protection effect, less tooth fracture [78.1% (250/320) in 2013 and 82.5% (330/400) in 2022], followed by low dropout rate [62.5% (200/320) in 2013 and 68.0% (272/400) in 2022]. The proportions of stainless steel crowns restoration for primary molars after root canal therapy were 51.3% (312/608) and 76.6% (392/512) respectively with statistically significant (χ2=75.88, P<0.001). The proportions after pulp capping treatment for deep caries were 13.2% (80/608) and 53.1% (272/512) respectively, and the difference was statistically significant (χ2=206.01,P<0.001). Conclusions: During the 10 years from 2013 to 2022, the technical sensitivity of stainless steel crowns had gradually decreased, and the application in China had gradually increased. However, some hospitals have not yet equipped, which limits the application of stainless steel crowns. Therefore, training efforts should be derived to promote the clinical popularization of stainless steel crowns.

[Association of category of dietary intake and physical activity with the risk of mortality in patients with type 2 diabetes mellitus: a prospective cohort study]

Objective: To investigate the association between dietary intake and physical activity category and their combined effects on all-cause and cause-specific mortality risk in patients with type 2 diabetes mellitus (T2DM). Methods: Between December 2013 and December 2021, a prospective cohort study was conducted on 19 863 T2DM patients in Changshu City, Qingjiangpu District (formerly Qinghe District), and Huai'an District, included in the national basic health service management. Information on deaths and underlying causes of death was obtained from the Jiangsu Provincial CDC and Prevention Death Surveillance System. Cox proportional hazards models were used to estimate the intensity of associations between dietary intake, physical activity, and their combined effects with all-cause and cause-specific mortality in patients with T2DM. Results: As of December 31, 2021, the research subjects had been followed up for 150 283 person-years, with a median follow-up time of 8.15 years. During the follow-up period, 3 293 people died, including 1 124 deaths from cardiovascular disease (CVD) and 875 deaths from cancer. Cox regression analysis showed that compared with the population of 0-1 recommended food group, those having more than five recommended food groups had a 19% lower risk of all-cause mortality [hazard ratio (HR)=0.81, 95%CI: 0.70-0.94] and a 33% lower risk of all-cause mortality (HR=0.67, 95%CI: 0.52-0.87). Compared with the T2DM population in the physical activity Q1 group, the risk of all-cause mortality, CVD mortality, and cancer mortality among the physical activity Q4 group reduced by 50% (HR=0.50, 95%CI: 0.45-0.56), 50% (HR=0.50, 95%CI: 0.41-0.61), and 27% (HR=0.73, 95%CI: 0.60-0.88), respectively. The combined effect showed that compared with the population in the intake of food categories 0-2 and low physical activity groups, the risk of all-cause, CVD mortality, and cancer mortality in the intake of food categories 4-9 and high physical activity groups reduced by 55% (HR=0.45, 95%CI: 0.38-0.53), 56% (HR=0.44, 95%CI: 0.32-0.59), and 40% (HR=0.60, 95%CI: 0.44-0.82), respectively. Conclusion: Type of dietary intake, physical activity, and their combined effects are associated with a reduced mortality risk in patients with T2DM.

Evaluation of a Deep-Learning Auto-Segmentation Model of Cardiac Substructures

PURPOSE/OBJECTIVE(S)

Increasing evidence has suggested that limiting dose not only to the whole heart but also to cardiac substructures can potentially reduce cardiac toxicities. Manual contouring of cardiac substructure can be challenging and time-consuming. To address this concern, we developed a deep learning (DL) model, trained on convolutional neural network algorithms in large external datasets, for auto-segmentation of cardiac substructures. This study aimed to evaluate the quality of the cardiac substructure contours generated by the DL algorithm.

MATERIALS/METHODS

We identified 28 patients with esophagus or gastroesophageal junction cancer from a single institution who received radiation to the esophagus between January 2017 and December 2022. For each case, the DL-generated cardiac substructures (4 heart chambers - left/right atrium [L/RA] and L/R ventricle [L/RV], 4 coronary arteries - L common [LCA], L anterior descending [LAD], L circumflex [LCx], and R common [RCA], and great vessels - ascending aorta [AA], pulmonary artery [PA], and superior vena cava [SVC]) were modified by two radiation oncologists (RO) using the contouring atlas developed by Duane et al. Spatial overlapping of the contours were then assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (HD-95), and normalized surface dice at 2 mm tolerance (NSD-2).

RESULTS

The mean values of DSC, HD-95, and NSD-2 are shown in Table 1. Overall, the mean DSC, HD-95, and NSD-2 for the heart chambers ranged from 0.82 to 0.92, 0.40 cm to 1.52 cm, and 0.68 to 0.85, respectively. Ranges of the mean DSC, HD-95, and NSD-2 for the coronary vessels were 0.41 to 0.74, 0.18 cm to 0.98 cm, and 0.66 to 0.77, respectively. Lastly, comparison of the great vessel contours yielded the following ranges for mean DSC, HD-95, and NSD-2 respectively: 0.72 to 0.92, 0.30 cm to 1.64 cm, and 0.65 to 0.83.

CONCLUSION

Our study demonstrates that auto-segmentation of cardiac substructures by DL-powered models can be comparable to manual contours for certain cardiac substructures, namely the four heart chambers and great vessels. Further improvement of the DL on contouring of coronary vessels would be needed prior to the autosegmentation model being widely adopted.

Evaluation of 68Ga-Fibroblast Activation Protein Inhibitor vs. 18F-FDG as a Novel Radiotracer for Biologically Guided Radiation Therapy

PURPOSE/OBJECTIVE(S)

Real-time biology guided radiation therapy (BgRT) uses real-time positron emissions from a PET tracer during treatment to guide targeted radiation to cancerous lesions. Fibroblast activation protein alpha (FAP) is highly expressed on cancer-associated fibroblasts in tumors with low expression in normal tissues. While 18F-FDG-PET requires fasting and has background in the liver and brain, 68-Gallium labeled FAP inhibitor (FAPI) does not require fasting and has less background uptake. The goal of this study was to investigate the utility of FAPI as a potential universal fiducial for BgRT. We hypothesized that 68Ga-FAPI would be a better radiotracer than 18F-FDG, as assessed by the Normalized Minimal kBq/mL and the Normal Target Signal (NTS), two parameters used to gauge the suitability of BgRT.

MATERIALS/METHODS

PET-CTs were obtained for 50 patients with pancreatic, liver, lung, head & neck, and cervical cancer using 18F-FDG and 68Ga-FAPI (n = 10 for each). Four DICOM images were obtained per patient (FDG PET + CT, FAPI PET + CT). Radiation oncologists delineated the gross tumor volume (GTV) on PET images. A separate set of auto-contours were generated from the PET using an auto-threshold of 40% maximum SUV for all tumors. A 1 cm expansion was added to the GTV to create a ring around the physician-generated contours and auto-contours. The following parameters were measured: GTV volume, SUV max of GTV, SUV mean of GTV, Normalized Minimal kBq/mL within the GTV, and NTS (= SUV max/Ring SUV mean). Values were compared using paired t-test. For the BgRT product with similar calculations, the required Normalized Minimal kBq/mL is > 5 kBq/mL; the required NTS is > 2.7 for treatment planning and > 2.0 for BgRT delivery.

RESULTS

The Normalized Minimal kBq/mL for FAPI was > 5 kBq/mL for all tumors and greater for auto-contoured GTVs compared to physician-contoured GTVs. The mean NTS for the auto-contours for all tumor sites was > 2.0. In addition, there was a statistically significant increase in the NTS for FAPI compared to FDG in pancreatic, liver and head & neck cancers. In pancreatic cancer, there was a statistically significant increase in Normalized Minimal kBq/mL for FAPI compared to FDG (26.0 vs 14.2) (p = 0.01) and the SUVmax of FAPI was almost double that of FDG (15.9 vs 8.2) (p = 0.01). FAPI had no background in the liver, but had high background in the uterus, suggesting it may have a role in liver cancer but not cervical cancer.

CONCLUSION

This is the first study demonstrating the potential superiority of 68Ga-FAPI compared to 18F-FDG as a biologic fiducial for BgRT when treating pancreatic, liver and head & neck cancers, with a similar efficacy for lung cancer. Our results indicate that auto-contoured GTVs generate a higher NTS than physician-contoured GTVs but all are > 2.0. In addition, the Normalized Minimal kBq/mL for auto-contours is > 5 kBq/mL for all tumors. As hypothesized, FAPI-based BgRT is most likely to be successful when treating tumors with significant desmoplastic stroma, such as pancreatic cancer.

Spatiotemporal Optimization of Pelvic Radiation Therapy

PURPOSE/OBJECTIVE(S)

Conformal and adaptive Radiation Therapy (RT) remains critical in the treatment of locally advanced pelvic cancers despite acute and late bowel complications. This work introduces spatiotemporal optimization of pelvic RT including mathematical modelling of intestinal radiobiology to evaluate a novel treatment planning approach for fractionated pelvic RT.

MATERIALS/METHODS

A single-plan fractionated RT delivery has n-fractions at dose/fraction = d and has biologically effective dose BED = nd ( 1 + d / [α/β] ) - ln(2) ([T - Tk] / [αTp]), where Tk and Tp are the kickoff time and doubling time of repopulation, and T is the time to deliver all fractions (including off-days). We present a parameterization of the repopulation BED-term to estimate a range of daily recovered BED including uncertainties in α and Tp. Recovery of BED as currently formulated is independent of the delivered dose; however, the assumption of spatiotemporal optimization is that a regional reduction of dose during RT by mixing treatment plans is critical to allow for normal tissue healing. We evaluate an achievable spatiotemporal optimization treatment planning strategy for an advanced stage prostate and a cervical cancer patient using 25-fraction delivery over 5-weeks and 4-weekends (T = 33 days) and propose 3 treatment plans: (1) a conformal "clinical standard" plan, (2) a right-bowel sparing plan, and (3) a left-bowel sparing plan. The plans are optimized to ensure no increased dose in opposing bowel or normal organs at risk (OARs).

RESULTS

For radiobiological parameters ranging from α = 0.2-0.35/Gy, α/β = 2-3 Gy, Tk = 5-10 days, and Tp = 3-7 days, parameterization shows daily BED recovery of 0.44±0.08 Gy (range = 0.28-0.69 Gy), or an average of 4Gy BED recovery for 5-days treatment surrounded by 2 weekends. Conservatively evaluating the 3.6Gy BED distribution in treatment planning may identify regions for complete recovery (after Tk days). In a prostate 3-plan set, the right- and left- bowel sparing plans deliver equivalent mean dose to targets and OARs to within 5cGy/fx. The clinical plan includes 298cc of bowel under 14Gy, but this same bowel will be spared throughout treatment. Delivery of the clinical plan in week 1 to achieve Tk days, followed by alternating the left and right plan each week has the potential to reduce BED to zero for an additional 116cc of bowel using the left-sparing plan in weeks 2 and 4, and 91cc using the right-bowel sparing plan in weeks 3 and 5. The cervical cancer plan-set was more challenging due to right-sided nodal volumes and higher clinical bowel dose; OAR mean dose variations were >8cGy/fx in a few organs, but the left- and right- sided sparing plans results in 394 cc and 139cc, respectively of unique spared bowel at the 3.6Gy/week threshold to potentially reach zero BED during treatment.

CONCLUSION

A novel spatiotemporal optimization of pelvic RT has the potential to preserve bowel, allow for increased intra-treatment intestinal tissue regeneration, and reduce radiation-induced complications.

Patterns of Care for Patients with Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy between 2016-2020: An NCDB Analysis

PURPOSE/OBJECTIVE(S)

Treatment for locally advanced rectal cancer (LARC), defined as T3/4 or any T with N+ disease, typically requires multi-modality management consisting of radiation (RT), chemotherapy (CHT), and surgery. Despite emerging evidence that total neoadjuvant therapy (TNT) is the preferred treatment of LARC, it remains unknown what proportion of patients are receiving TNT in the United States. Our objective was to (1) determine the proportion of patients with LARC receiving TNT over time, (2) determine the most common method in which TNT is being delivered, and (3) determine what factors are associated with a lower likelihood of receiving TNT in the United States.

MATERIALS/METHODS

Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with rectal cancer between 2016-2020. Patients were excluded if they had M1 disease, T1-2 N0 disease, incomplete staging information, non-adenocarcinoma histology, received RT to a non-rectum site, or received a non-definitive RT dose. Patients were determined to have received TNT if they (1) received RT and multi-agent (MA)-CHT prior to surgery, (2) had an interval of >180 days from the onset of neoadjuvant therapy to surgery if they received long course (LC)-chemoradiation (CRT) (based on 35 days for LC-CRT + 112 days for 8 cycles of MA-CHT + 30 days to surgery), or (3) had an interval of >150 days from the onset of neoadjuvant therapy to surgery if they received short course (SC)-RT (based on 5 days for SC-RT + 112 days for 8 cycles of MA-CHT + 30 days to surgery). Data were analyzed using linear regression, Chi-square test, and binary logistic regression.

RESULTS

Of the 26,375 patients included, the median age was 60 (range 21-90) years, with the majority of patients being <65 years old (65.6%), male (62.1%), and non-Hispanic white (77.0%). A total of 5,003 (19.0%) patients received TNT, and 21,372 (81.0%) patients received classical combined modality therapy (CMT). The proportion of patients receiving TNT increased significantly over time, from 6.1% in 2016, 9.0% in 2017, 15.3% in 2018, 25.8% in 2019, to 34.6% in 2020 (slope = 7.36, 95% CI 4.58-10.15, R2 = 0.96, p = 0.040). The most common TNT regimen was MA-CHT followed by LC-CRT (73.2% of cases from 2016-2020). The proportion of patients receiving SC-RT as part of TNT significantly increased from 2.8% in 2016, 1.7% in 2017, 4.6% in 2018, 7.3% in 2019, to 13.7% in 2020 (slope = 2.74, 95% CI 0.37-5.11, R2 = 0.82, p = 0.035). On multivariate analysis, factors associated with a lower likelihood of TNT use included age >65 (OR 0.66, 95% CI 0.61-0.71, p<0.001), female gender (OR 0.92, 95% CI 0.86-0.98, p = 0.014), Black race (OR 0.87, 95% CI 0.77-0.98, p = 0.024), and T3 N0 disease (OR 0.60, 95% CI 0.52-0.70, p<0.001).

CONCLUSION

TNT utilization rates have significantly increased in recent years, from 6.1% in 2016 to 34.6% in 2020. The observed trend appears to be in line with the recent National Comprehensive Cancer Network (NCCN) guidelines recommending TNT as the preferred approach.

Dosimetric Evaluation of Cardiac Substructures in Irradiation of Esophagus

PURPOSE/OBJECTIVE(S)

Due to the anatomic proximity of the heart, cardiac toxicity is a major concern in radiation treatment (RT) of esophageal cancer. Historically, the entire heart is considered an organ at risk. However, more recent studies have demonstrated that dose to cardiac substructures may better predict cardiac toxicities. We retrospectively reviewed patients (pts) who had RT to the distal esophagus and evaluated the dose-volume constraints (DVCs) of the cardiac substructures and the whole heart. We hypothesized that the majority of the treatment plans would not meet the DVCs to cardiac substructures noted in the current literature, albeit meeting commonly accepted whole heart DVCs.

MATERIALS/METHODS

We identified 27 pts with esophagus or gastroesophageal junction cancer who received RT to the esophagus between January 2017 and December 2022. For each case, the cardiac substructures (4 heart chambers - left/right atrium [L/RA] and left/right ventricle [L/RV], 4 coronary arteries - left common [LCA], left anterior descending [LAD], left circumflex [LCx], and right common [RCA], and great vessels - ascending and descending aorta [A/DA], pulmonary artery [PA], and superior vena cava [SVC]) were contoured based on the contouring atlas developed by Duane et al. DVCs based on existing literature for the whole heart and each cardiac substructure were reviewed and retrospectively analyzed for each treatment plan (Table 1).

RESULTS

Eighteen (66.7%) pts received 50 Gy/25 fractions, and nine (33.3%) pts received 50.4 Gy/28 fractions. The dose-volume constraints for the whole heart and each cardiac substructure are shown in Table 1. When considering the heart as a whole organ, all the treatment plans met the V45 and V40 objectives, with a mean V45 of 7.1% and V40 of 10.8%. All the cases also met the constraints for RV and PA. However, none of the cases met the DVCs for RA or LV. Only 6 (22.2%) of cases met the constraint for LCx or AA.

CONCLUSION

We found that despite all the treatment plans meeting the whole heart V45 and V40 constraints, none of the cases met the dose constraints to all cardiac substructures. This suggests that dosimetric evaluation of the whole heart alone may not be sufficient in minimizing cardiac toxicities from RT, and thus further supports the importance of defining the cardiac substructures. Future studies will be needed to standardize the dose constraints to these substructures to ensure patient safety.

[Effect of fluid viscosity on the biomechanical sequence of oropharyngeal swallowing in healthy males]

Objective: To confirm the effect of fluid with different viscosity on the normal biomechanical sequence of oropharyngeal swallowing in healthy males. Methods: Fifteen healthy male subjects [(27.7±1.8) years old] were recruited from November 2011 to February 2012 and instructed to swallow 15 ml of water (W), nectar-like fluid (N), and honey-like fluid (H) in an upright sitting position. The sensing system was consisted of tongue pressure sensor sheet, bend sensor, surface electrodes and microphone. They were used to monitor tongue pressure, hyoid activity, surface electromyography (EMG) of swallowing-related muscles and swallowing sound, respectively. The swallowing sound was chosen as the reference time. The significance of biomechanical sequence of structural events was determined by repeated-measures analysis of variance (ANOVA). Results: When swallowing liquid of any consistency, hyoid premotor and suprahyoid muscle electromyography (EMG) appeared synchronously (P>0.05), followed by the simultaneous appearances of hyoid rapid movement, peak time of suprahyoid muscle EMG, onset of infrahyoid muscle EMG, and anterior tongue pressure production (P>0.05). The peak time of infrahyoid muscle EMG was very close to the peak time of anterior tongue pressure (P>0.05), and both of them were earlier than the time that the hyoid reaching the highest position (P<0.05). At last, the time that the hyoid departing the highest position was synchronized with the disappearances of suprahyoid muscle EMG, infrahyoid muscle EMG, and tongue pressure (P>0.05). The tongue pressure production and peak time of tongue pressure arose from anterior to posterior along the midline of hard palate during normal swallowing, with the significances for tongue pressure production between the anterior site and the middle site (W: P=0.035, N: P=0.027, H: P=0.013) as well as the anterior site and the posterior site (W: P<0.001, N: P<0.001, H: P<0.001), while the appearance and peak time of the circumferential tongue pressure were very close (P>0.05). The increase of fluid viscosity did not affect the biomechanical sequence of the above structural physiological movements during normal swallowing. There were statistically significant differences between the hyoid premotor and the onset of suprahyoid muscle EMG when swallowing the honey-like liquid [(-1.03±0.47) and (-0.90±0.50) s] and water[(-0.87±0.32) and (-0.74±0.31) s] (P<0.001). Among the delayed structural events, except for the onset of infrahyoid muscle EMG and the tongue pressure production on the anterior site (P>0.05), the occurrences of all the parameters in swallowing honey-like fluid were significantly later than those in swallowing water (onset of hyoid rapid movement, P=0.007; time of hyoid reaching the highest position, P=0.034; time of hyoid departing the highest position, P=0.041; offset of hyoid movement, P=0.035; peak time of suprahyoid muscle EMG: P=0.040; offset of suprahyoid muscle EMG, P=0.014; peak time of infrahyoid muscle EMG: P=0.042; offset of infrahyoid muscle EMG, P=0.028; peak time of Ch.1: P=0.045; offset of Ch.1: P=0.012; onset of Ch.2: P=0.038; peak time of Ch.2: P=0.009; offset of Ch.2: P=0.034; onset of Ch.3: P=0.043; peak time of Ch.3: P=0.011; offset of Ch.3: P=0.026;onset of Ch.4: P=0.040; peak time of Ch.4: P=0.038; offset of Ch.4: P=0.033; onset of Ch.5: P=0.046; peak time of Ch.5:P=0.028; offset of Ch.5: P<0.001), but not for those between nectar-like fluid and honey-like fluid (P>0.05). Conclusions: The alteration of fluid viscosity did not affect healthy male biomechanical sequence of tongue, hyoid and swallowing-related muscles during normal swallowing. The biomechanics of the oropharyngeal structures is physiologically regulated with the alteration of fluid viscosity to ensure swallowing safely and smoothly.

[Urban-rural disparities of depression symptoms and its influencing factors among the elderly aged ≥65 years old in Anhui Province from 2019 to 2020]

Objective: To analyze the difference in depression symptoms and influencing factors between urban and rural elderly people aged ≥65 years old in Anhui Province. Methods: Based on the data from a survey of 68 communities in Anhui Province that implemented the National Elderly Psychological Care Project from 2019 to 2020, the current status of depression symptoms in the elderly was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The difference in the detection rate of depression symptoms between urban and rural elderly people with different characteristics was compared by using the χ2 test. The logistic regression model was used to analyze the relevant factors of depression symptoms in urban and rural elderly people. Results: A total of 15 532 elderly people aged≥65 years old were included in the survey. The detection rate of depressive symptoms was 7.12%, which was higher in rural areas (9.08%) than in urban areas (6.48%). Logistic regression showed that chronic diseases were risk factors for depressive symptoms in elderly people from both urban and rural areas. Positive attitudes towards aging and good mental resilience were protective factors for depressive symptoms in elderly people. Having hobby (OR=0.64, 95%CI: 0.45-0.91), good relationship with children (OR=0.56, 95%CI: 0.41-0.76), good relationship with spouse (OR=0.51, 95%CI: 0.37-0.71), and having at least 6 friends (OR=0.48, 95%CI: 0.32-0.71) were the protective factors for depressive symptoms in urban elderly people. A good relationship with neighbors (OR=0.58, 95%CI: 0.41-0.82) and having 1-2 friends (OR=0.40, 95%CI: 0.25-0.64) were the protective factors for depressive symptoms in rural elderly people. Women (OR=1.49, 95%CI: 1.06-2.10) and higher education level (OR=1.81, 95%CI: 1.19-2.74, compared with illiterate/semi-illiterate in primary school; OR=2.94, 95%CI: 1.82-4.76, compared with illiterate/semi-illiterate in junior high school and above) were the risk factors for depressive symptoms in rural elderly people. Conclusion: There are differences between urban and rural areas in depressive symptoms among elderly people in Anhui Province. The detection rate of depression symptoms among rural elderly people is higher, and the influencing factors of depressive symptoms between urban and rural elderly people are also different, which should be treated specifically in the implementation of intervention measures.

[Expression of Mas1 receptor in human placenta and its effect on the function of trophoblast cells in pre-eclampsia patients]

Objective: To investigate the expression change of the Mas1 receptor in the placenta of healthy pregnant women during different gestation periods, analyze the expression level of the Mas1 receptor in the placenta of pre-eclampsia (PE) patients, and its biological function in trophoblast cells. Methods: Placental villous tissues were collected from normal pregnant women in early, mid and late pregnancy. Human trophoblast stem cells were isolated and cultured from early pregnancy villous tissues. The expression of the Mas1 receptor was detected by fluorescence immunoassay and real-time fluorescence quantitative PCR. In a case-control study, patients with full-term PE were selected as the case group and healthy women with full-term pregnancy were selected as the control group. Placental villus tissues were collected from both groups. Immunofluorescence chemistry and immunoprotein blotting were used to study the changes in Mas1 receptor expression in PE. Mas1 receptor agonists and blockers induced HTR8/Svneo cells and BeWo cells, and the effects of the Mas1 receptor on the proliferation and migration of trophoblast cells were detected by the CCK8 proliferation test and scratch test. Results: Eight cases were included in early pregnancy, seven cases in mid-pregnancy and six cases in late pregnancy. Mas1 receptors in normal placental villi tissue were mainly expressed in human trophoblast stem cell membranes and cytoplasm, and the expression of Mas1 receptor mRNA in villi tissue was significantly higher in late pregnancy than in mid-pregnancy. There were 24 cases included in the case group and 12 cases in the control group. Mas1 receptor expression in placental villi was significantly lower in the case group compared to the control group; Activation/inhibition of the Mas1 receptor had no significant effect on the proliferation of HTR8/Svneo cells and BeWo cells. Activated Mas1 receptor had no significant effect on the migration ability of HTR8/Svneo cells. Conclusion: Mas1 receptors are expressed in placental villous tissue and their expression varies with gestation. Mas1 receptor expression is reduced in PE patients, but it does not affect the value-added or migratory function of trophoblast cells.

[A prospective cohort study of long-term fasting blood glucose variability and risk of mortality in patients with type 2 diabetes]

Objective: To investigate the association between long-term fasting blood glucose (FPG) variability and all-cause mortality in patients with type 2 diabetes. Methods: A total of 7 174 type 2 diabetic patients included in National Basic Public Health Service Program in Changshu of Jiangsu Province were recruited as participants. Long-term glucose variability was assessed using standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM) across FPG measurements at the more than three visits. Death information were mainly obtained from the death registry system in Jiangsu. Then Cox proportional hazards regression models were used to estimate the associations of four variability indicators and all-cause mortality's hazard ratios (HRs) and their 95%CIs. Results: Among 55 058.50 person-years of the follow-up, the mean follow-up time was 7.67 years, and 898 deaths occurred during the follow-up period. After adjustment, compared with T1 group, the Cox regression model showed that HRs of T3 group in SD, CV, ARV and VIM were 1.24 (95%CI: 1.03-1.49), 1.20 (95%CI: 1.01-1.43), 1.28 (95%CI: 1.07-1.55) and 1.20 (95%CI:1.01-1.41), respectively. HRs of per 1 SD higher SD, CV, ARV and VIM were 1.13 (95%CI: 1.06-1.21), 1.08 (95%CI: 1.01-1.15), 1.05 (95%CI: 1.00-1.12) and 1.09 (95%CI: 1.02-1.16) for all-cause mortality, respectively. In the stratified analysis, age, gender, hypoglycemic agent and insulin uses had no effect on the above associations (all P for interaction >0.05). Conclusion: Long-term FPG glycemic variability was positively associated with the risk of all-cause mortality in type 2 diabetes patients.

[HbA1c comparison and diagnostic efficacy analysis of multi center different glycosylated hemoglobin detection systems]

Objective: Compare and analyze the results of the domestic Lanyi AH600 glycated hemoglobin analyzer and other different detection systems to understand the comparability of the detection results of different detectors, and establish the best cut point of Lanyi AH600 determination of haemoglobin A1c (HbA1c) in the diagnosis of diabetes. Methods: Multi center cohort study was adopted. The clinical laboratory departments of 18 medical institutions independently collected test samples from their respective hospitals from March to April 2022, and independently completed comparative analysis of the evaluated instrument (Lanyi AH600) and the reference instrument HbA1c. The reference instruments include four different brands of glycosylated hemoglobin meters, including Arkray, Bio-Rad, DOSOH, and Huizhong. Scatter plot was used to calculate the correlation between the results of different detection systems, and the regression equation was calculated. The consistency analysis between the results of different detection systems was evaluated by Bland Altman method. Consistency judgment principles: (1) When the 95% limits of agreement (95% LoA) of the measurement difference was within 0.4% HbA1c and the measurement score was≥80 points, the comparison consistency was good; (2) When the measurement difference of 95% LoA exceeded 0.4% HbA1c, and the measurement score was≥80 points, the comparison consistency was relatively good; (3) The measurement score was less than 80 points, the comparison consistency was poor. The difference between the results of different detection systems was tested by paired sample T test or Wilcoxon paired sign rank sum test; The best cut-off point of diabetes was analyzed by receiver operating characteristic curve (ROC). Results: The correlation coefficient R² of results between Lanyi AH600 and the reference instrument in 16 hospitals is≥0.99; The Bland Altman consistency analysis showed that the difference of 95% LoA in Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180) was -0.486%-0.325%, and the measurement score was 94.6 points (473/500); The difference of 95% LoA in the Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant II) was -0.727%-0.612%, and the measurement score was 89.8 points; The difference of 95% LoA in the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT) was -0.231%-0.461%, and the measurement score was 96.6 points; The difference of 95% LoA in the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT) was -0.469%-0.479%, and the measurement score was 91.9 points. The other 14 hospitals, Lanyi AH600, were compared with 4 reference instrument brands, the difference of 95% LoA was less than 0.4% HbA1c, and the scores were all greater than 95 points. The results of paired sample T test or Wilcoxon paired sign rank sum test showed that there was no statistically significant difference between Lanyi AH600 and the reference instrument Arkray HA8180 (Z=1.665,P=0.096), with no statistical difference. The mean difference between the measured values of the two instruments was 0.004%. The comparison data of Lanyi AH600 and the reference instrument of all other institutions had significant differences (all P<0.001), however, it was necessary to consider whether it was within the clinical acceptable range in combination with the results of the Bland-Altman consistency analysis. The ROC curve of HbA1c detected by Lanyi AH600 in 985 patients with diabetes and 3 423 patients with non-diabetes was analyzed, the area under curve (AUC) was 0.877, the standard error was 0.007, and the 95% confidence interval 95%CI was (0.864, 0.891), which was statistically significant (P<0.001). The maximum value of Youden index was 0.634, and the corresponding HbA1c cut point was 6.235%. The sensitivity and specificity of diabetes diagnosis were 76.2% and 87.2%, respectively. Conclusion: Among the hospitals and instruments currently included in this study, among these four hospitals included Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180), Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant Ⅱ), the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT), and the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT), the comparison between Lanyi AH600 and the reference instruments showed relatively good consistency, while the other 14 hospitals involved four different brands of reference instruments: Arkray, Bio-Rad, DOSOH, and Huizhong, Lanyi AH600 had good consistency with its comparison. The best cut point of the domestic Lanyi AH600 for detecting HbA1c in the diagnosis of diabetes is 6.235%.

[Incremental value of epicardial fat volume on predicting obstructive coronary artery disease with myocardial ischemia]

Objective: This study aimed to investigate the association between epicardial fat volume (EFV) and obstructive coronary artery disease (CAD) with myocardial ischemia, and evaluate the incremental value of EFV on top of traditional risk factors and coronary artery calcium (CAC) in predicting obstructive CAD with myocardial ischemia. Methods: This study was a retrospective cross-sectional study. Patients with suspected CAD who underwent coronary angiography (CAG) and single photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) at the Third Affiliated Hospital of Soochow University from March 2018 to November 2019 were consecutively enrolled. EFV and CAC were measured by non-contrast chest computed tomography (CT) scan. Obstructive CAD was defined as coronary artery stenosis≥50% in at least one of the major epicardial coronary arteries, and myocardial ischemia was defined as reversible perfusion defects in stress and rest MPI. Obstructive CAD with myocardial ischemia was defined in patients with coronary stenosis severity≥50% and reversible perfusion defects in the corresponding areas of SPECT-MPI. Patients with myocardial ischemia bot without obstructive CAD were defined as none-obstructive CAD with myocardial ischemia group. We collected and compared the general clinical data, CAC and EFV between the two groups. Multivariable logistic regression analysis was performed to identify the relationship between EFV and obstructive CAD with myocardial ischemia. ROC curves were performed to determine whether addition of EFV improved predictive value beyond traditional risk factors and CAC for obstructive CAD with myocardial ischemia. Results: Among the 164 patients with suspected CAD, 111 patients were males, and average age was (61.4±9.9) years old. 62 (37.8%) patients were included into the obstructive CAD with myocardial ischemia group. 102 (62.2%) patients were included into the none-obstructive CAD with myocardial ischemia group. EFV was significantly higher in obstructive CAD with myocardial ischemia group than in none-obstructive CAD with myocardial ischemia group ((135.63±33.29)cm³ and (105.18±31.16)cm³, P<0.01). Univariate regression analysis showed the risk of obstructive CAD with myocardial ischemia increased by 1.96 times for each SD increase in EFV(OR 2.96; 95%CI, 1.89-4.62; P<0.01). After adjustment for traditional risk factors and CAC, EFV remained as an independent predictor for obstructive CAD with myocardial ischemia (OR, 4.48, 95%CI, 2.17-9.23; P<0.01). Addition of EFV to CAC and traditional risk factors was related to larger AUC for predicting obstructive CAD with myocardial ischemia (0.90 vs. 0.85, P=0.04, 95%CI: 0.85-0.95) and the global chi-square increased by 21.81 (P<0.05). Conclusions: EFV is an independent predictor for obstructive CAD with myocardial ischemia. Addition of EFV to traditional risk factors and CAC has incremental value for predicting obstructive CAD with myocardial ischemia in this patient cohort.

Measurement of the ^{18}O(α, γ)^{22}Ne Reaction Rate at JUNA and Its Impact on Probing the Origin of SiC Grains

The ^{18}O(α,γ)^{22}Ne reaction is critical for AGB star nucleosynthesis due to its connection to the abundances of several key isotopes, such as ^{21}Ne and ^{22}Ne. However, the ambiguous resonance energy and spin-parity of the dominant 470 keV resonance leads to substantial uncertainty in the ^{18}O(α,γ)^{22}Ne reaction rate for the temperature of interest. We have measured the resonance energies and strengths of the low-energy resonances in ^{18}O(α,γ)^{22}Ne at the Jinping Underground Nuclear Astrophysics experimental facility (JUNA) with improved precision. The key 470 keV resonance energy has been measured to be E_{α}=474.0±1.1  keV, with such high precision achieved for the first time. The spin-parity of this resonance state is determined to be 1^{-}, removing discrepancies in the resonance strengths in earlier studies. The results significantly improve the precision of the ^{18}O(α,γ)^{22}Ne reaction rates by up to about 10 times compared with the previous data at typical AGB temperatures of 0.1-0.3 GK. We demonstrate that such improvement leads to precise ^{21}Ne abundance predictions, with an impact on probing the origin of meteoritic stardust SiC grains from AGB stars.

[Development of parenting behavior scale for caregivers of children aged 2 to 6 years and analysis for its reliability and validity]

To develop a caregiver parenting behavior scale for children aged 2 to 6 years, and to verify its reliability and validity. This study recruited 1 350 caregivers of children aged 2 to 6 years. The item discrimination analysis and exploratory factor analysis were used to analyze the structure, dimensions and items of the scale. Homogeneity reliability, split-half reliability and test-retest reliability were used to analyze the reliability of the scale. Content validity and construct validity were used to analyze the validity of the scale. The results showed that the final scale contained 7 dimensions and 45 items. Cronbach's α coefficient of the total scale was 0.945; the coefficient of split half was 0.899; the test-retest reliability analysis showed that the correlation coefficients between the two tests were 0.893 (total score), 0.854 (social), 0.832 (language), 0.871 (gross motor), 0.893 (fine motor), 0.862 (cognitive), 0.832 (self-care), and 0.872 (sensory). The content validity analysis was carried out by two rounds of expert argumentation using Delphi expert consultation method. The Kendall coefficient of the items score in two rounds of Delphi expert consultation was 0.813 (P<0.01). The structure validity analysis showed that there were significant correlations between each dimension and the total scale, also between each dimension of the scale, and the extracted average variance values of each dimension was greater than the correlation coefficients between this dimension and other dimensions. In conclusion, the reliability and validity of the scale are qualified. It can be used as a tool to evaluate and guide the parenting behavior of caregivers of children aged 2 to 6 years.

Improper food handling and its associated characteristic factors among domestic food handlers in rural areas of Anhui Province in China

Improper domestic food handling in rural areas of China is an important public health issue leading to foodborne illness. However, the underlying factors responsible for poor domestic food hygiene practices have not been comprehensively studied. Here, a cross-sectional study was conducted in Anhui Province, China between 2015 - 2016, using a questionnaire to collect data from 819 respondents, selected using multistage cluster random sampling techniques. Multivariate logistic regression analysis was then used to assess the demographic factors associated with improper food handling. Results showed that 525 (64.1%) of respondents used improper food handling techniques. The factors associated with improper food handling included gender, age, education, income, and occupation. Males (vs. females), adults aged ≥ 50 years (vs. those aged 18 - 30 years), individuals with primary school education or lower (vs. individuals with a bachelor’s degree or higher), individuals with annual incomes of < 4,387 USD (vs. income ≥ 13,161 USD), and workers (vs. other occupation groups) were more likely to report inappropriate food handling practices in rural areas. The results obtained from the present work may provide the basis for training in domestic food safety hygiene/handling practices in rural areas of China in order to reduce the incidence of foodborne illnesses.

[Bacterial community diversity in Dermatophagoides farinae using high-throughput sequencing]

OBJECTIVE

To investigate the bacterial community diversity in Dermatophagoides farinae.

METHODS

Laboratory-cultured D. farinae was collected, and the composition of microbial communities was determined by sequence analyses of the V4 region in the bacterial 16S ribosomal RNA (16S rRNA) gene on an Illumina PE250 high-throughput sequencing platform. Following quality control and filtering of the raw sequence files, valid reads were obtained and subjected to operational taxonomic units (OTU) clustering and analysis of the composition of microbial communities and alpha diversity index using the Usearch software, Silva database, and Mothur software.

RESULTS

A total of 187 616 valid reads were obtained, and 469 OTUs were clustered based on a sequence similarity of more than 97%. OTU annotation showed that the bacteria in D. farinae belonged to 26 phyla, 43 classes, 100 orders, 167 families and 284 genera. The bacteria in D. farinae were mainly annotated to five phyla of Proteobacteria, Firmicutes, Bacteroidota, Actinobacteriota, and Acidobacteriota, with Proteobacteria as the dominant phylum, and mainly annotated to five dominant genera of Ralstonia, norank-f-Mitochondria, Staphylococcus and Sphingomonas, with Wolbachia identified in the non-dominant genus.

CONCLUSIONS

A high diversity is identified in the composition of the bacterial community in D. farinae, and there are differences in bacterial community diversity and abundance among D. farinae.

[A cross-sectional study of prevalence of chronic kidney disease and related factors in adults in Anhui province]

Objective: To understand the prevalence of chronic kidney disease (CKD) and related factors in adults in Anhui province based on the data of Chinese Chronic Diseases and Nutrition Surveillance program (2018) in Anhui. Methods: Multi-stage stratified cluster random sampling was used to select participants aged ≥18 years. Moreover, questionnaire survey, body measurements and laboratory tests were conducted. The complex weighting method was used to estimate the prevalence of CKD in residents with different characteristics, and complex sampling data logistic regression model was used for multivariate analysis to identify related risk factors. Results: A total of 7 181 participants were included. The overall prevalence of CKD was 11.06% in adults in Anhui, and the prevalence was 12.49% in women and 9.59% in men (P<0.05). The moderate, high and very high risk for CKD progression were 8.66%, 2.02% and 0.38%, respectively. Multivariate analysis showed that age (OR=1.03, 95%CI: 1.00-1.05), BMI (OR=1.05, 95%CI: 1.01-1.09), being woman (OR=1.38,95%CI: 1.22-1.55), hypertension (OR=2.50, 95%CI: 1.76-3.56), diabetes (OR=2.28, 95%CI: 1.51-3.43), dyslipidemia (OR=1.26, 95%CI: 1.11-1.43) and hyperuricemia (OR=2.16, 95%CI: 1.68-2.78) were risk factors for CKD. Conclusion: The prevalence of CKD in adults in Anhui was relatively high and age, gender, BMI, hypertension, diabetes, dyslipidemia and hyperuricemia were found to be associated with the prevalence of CKD. To prevent CKD and its complications, attention should be paid to the management of related risk factors, including overweight and obesity, hypertension, diabetes, dyslipidemia and hyperuricemia.

[A prospective cohort study on socioeconomic status and risk of all-cause mortality among patients with type 2 diabetes based on latent class analysis]

Objective: To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area. Results: Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively. Conclusions: Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations.

Deep Underground Laboratory Measurement of ^{13}C(α,n)^{16}O in the Gamow Windows of the s and i Processes

The ^{13}C(α,n)^{16}O reaction is the main neutron source for the slow-neutron-capture process in asymptotic giant branch stars and for the intermediate process. Direct measurements at astrophysical energies in above-ground laboratories are hindered by the extremely small cross sections and vast cosmic-ray-induced background. We performed the first consistent direct measurement in the range of E_{c.m.}=0.24 to 1.9 MeV using the accelerators at the China Jinping Underground Laboratory and Sichuan University. Our measurement covers almost the entire intermediate process Gamow window in which the large uncertainty of the previous experiments has been reduced from 60% down to 15%, eliminates the large systematic uncertainty in the extrapolation arising from the inconsistency of existing datasets, and provides a more reliable reaction rate for the studies of the slow-neutron-capture and intermediate processes along with the first direct determination of the alpha strength for the near-threshold state.

[The assistant effects of porcine fibrin sealant in improving stone clearance rate in flexible ureteroscopy lithotripsy in ex vivo porcine kidney model]

Objectives: To investigate the feasibility of using a porcine fibrin sealant to wrap and remove kidney calculi fragments through an isolated porcine kidney model. Methods: In the isolated porcine kidney stone model (implanted with 100 mg, air dried, ≤1 mm human stone fragments, n=6;implanted with 100 mg, air dried, ≤3 mm human stone fragments, n=6), the ureteral soft mirror combined with the 12/14Fr UAS was used to test the effect of stone extraction using only two stone extraction methods: basket extraction (control group, ≤1 mm stone fragments, n=3; ≤3 mm stone fragments, n=3) and basket-sealant extraction (test group, ≤1 mm stone fragments, n=3; ≤3 mm stone fragments, n=3). Compare the stone removal rate and operation time of the two stone retrieval methods. The sealant was put into urine of normal human and observed. Results: Porcine Fibrin Sealant can form a gel in saline and urine and adhere and wrap stone fragments. The time of procedures of test (basket-sealant) and control (basket) group in kidneys implanted with ≤ 1 mm stone fragments were (14.0±4.2) and (29.0±0.7)min (P<0.05) stone clearance rates were (90.9±1.4)% and (48.4±15.7)% (P<0.05), respectively. In kidneys implanted with ≤ 3 mm fragments, time of procedures were (12.8±4.0) and (30.0±0)min (P<0.05) Stone clearance rates were (91.1±5.0)% and (20.7±8.0)% (P<0.05). The Sealant dissolves by itself in normal human urine and normal saline at 37 ℃ for 24 hours. Conclusion: The appropriate concentration of Porcine Fibrin Sealant assisted stone retrieval may become a new method for removing small stone fragments in retrograde intrarenal surgery.

POS1249 EFFICACY AND SAFETY OF ChAdOx1 nCoV-19/AZD1222 AND mRNA-1273 VACCINES: A COMPARATIVE STUDY IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES

Background

Several studies have demonstrated immunogenicity after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD) [1], but the differences between mRNA-based and vector vaccines and the cellular responses to COVID-19 vaccines according to distinct immunogenicity in AIRD patients are still unclear.

Objectives

To investigate the differences in efficacy and safety between the vector vaccine ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) and mRNA-based vaccine mRNA-1273 (Moderna) in patients with AIRD, and to explore the cell-cell interactions between high and low anti-SARS-CoV-2 IgG levels in patients with rheumatic arthritis (RA) by single-cell RNA sequencing (scRNA-seq).

Methods

From September 16 to November 15, 2021, we consecutively enrolled 243 participants aged ≥20 years with AIRD who received COVID-19 vaccination, of whom 113 were immunized with AZD1222 and 130 with mRNA-1273. The level of serum IgG antibodies to the SARS-CoV-2 receptor-binding domain on the spike protein S1 subunit was quantified by electrochemiluminescence immunoassay at 4-6 weeks after vaccination. Moreover, peripheral blood mononuclear cells were isolated from two RA patient with high anti-SARS-CoV-2 IgG level and four RA patients with low level for scRNA-seq and cell-cell communication signal was analyzed by CellChat.

Results

The anti-SARS-CoV-2 IgG seropositivity rate was 78.8% (89/113) for AZD1222 and 83.1% (108/130) for mRNA-1273. The level of anti-SARS-CoV-2 IgG was higher in patients who received mRNA-1273 than in those who received AZD1222 (β: 30.15, 95% CI: 11.67-48.63, p=0.002) (Table 1). Prednisolone-equivalent dose >5 mg/day and methotrexate (MTX) use in AIRD patients, and non-anti-tumor necrosis factor (TNF)-α biologics and Janus kinase (JAK) inhibitor use in RA patients were associated with inferior immunogenicity. ScRNA-seq revealed CD16-monocytes were predominant in RA patients with high anti-SARS-CoV2-IgG antibody level, and enriched pathways related to antigen presentation via major histocompatibility complex class II (MHC class II) were found (Figure 1). HLA-DRA and CD4 interaction was vigorous among all identified MHC-II pathway and was enhanced in high anti-SARS-CoV2-IgG antibody group.

Table 1.

Multivariate analysis of anti-SARS-CoV-2 IgG level in patients with rheumatic diseases following COVID-19 vaccines

Multivariate analysisβ95% CIp valueMedicationsGlucocorticoidsNot usedReference≤5 mg/day−22.48(−56.33,11.37)0.192>5 mg/day−23.45(−43.54,-3.36)0.022Methotrexate−24.89(−45.70,-4.08)0.019Targeted therapiesTargeted therapies group Not usedReference TNF inhibitor−15.78(−41.33,9.76)0.224 Non-TNF bDMARD−25.27(−55.47,4.93)0.100 JAK inhibitor−17.08(−47.23,13.07)0.265VaccineChAdOx1 nCoV-19/AZD1222ReferencemRNA-127330.15(11.67,48.63)0.002

TNF: tumor necrosis factor, bDMARDs: biologic disease-modifying antirheumatic drugs, JAK: Janus kinase.

Figure 1.

The comprehensive cell atlas of PBMC of RA patients with high and low anti-SARS-CoV2-IgG antibodies. A) UMAP visualization of PBMC cells from RA patients. B) The proportion of cell types between high and low antibody groups. C) Volcano plot of CD16-monocyte showed differential expressed genes. D) Pathway analysis between high and low antibody groups; PRBC: peripheral blood mononuclear cell, RA: rheumatoid arthritis, NK cell: natural killer cell, pDC: plasmacytoid dendritic cell, CLP: common lymphoid progenitor.

Conclusion

mRNA-1273 and AZD1222 vaccines exhibited differential immunogenicity in patients with AIRD. Enriched pathways related to antigen presentation via MHC class II in CD16-monocytes might be associated with higher anti-SARS-CoV2-IgG level in RA patients and further study is warranted.

References

[1]Geisen UM, Berner DK, Tran F, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Ann Rheum Dis. 2021;80:1306-1311.

Acknowledgements

The authors thank the Biostatistics Task Force of Taichung Veterans General Hospital for their assistance with the statistical analysis in this study.

Disclosure of Interests

None declared

[Influence of systemic diseases on the diagnosis and treatment of dental diseases and prevention of related risks]

Patients with dental problems may suffer from various systemic diseases at the same time. The concomitant systemic diseases can have impacts and risks on the diagnosis, treatment planning and therapeutic practice in dentistry. The author briefly expounds the influences of systemic diseases on dental diagnosis and treatment and the prevention of risks from seven aspects: cardio-cerebral vascular system, blood system, respiratory system, endocrine system, digestive system, genitourinary system, nervous system and mental system, in order to provide references for the dental clinicians.

[Consensus of experts on the oral health management and medical risk prevention for the patients with chronic airway diseases (2022 edition)]

Today, there is greater awareness on the association between oral diseases and respiration diseases after the outbreak of COVID-19. However, confusion regarding the oral health management and medical risk prevention for patients with chronic airway diseases has been remained among dental clinicians. Therefore, the dental experts of the Fifth General Dentistry Special Committee, Chinese Stomatological Association, combined with the experts of respiratory and critical care medicine, undertook the formation of consensus on the oral health management of patients with chronic airway diseases in order to help dental clinicians to evaluate medical risks and make better treatment decision in clinical practice. In the present consensus report, the relationship of oral diseases and chronic airway diseases, the oral health management and the treatment recommendations of patients with chronic airway diseases are provided.

[Consensus of experts on the medical risk prevention for the patients with cardiovascular diseases during dental treatment (2022 edition)]

With the aging process of population in the society, the prevalence of cardiovascular diseases (CVD) in China is increasing continuously and the number of dental patients with CVD is increasing gradually too. Due to the lack of guidelines for dental patients with CVD in our country, how to implement standardized preoperative evaluation and perioperative risk prevention remains a problem to be solved for dentists at present. The present expert consensus was reached by combining the clinical experiences of the expert group of the Fifth General Dentistry Special Committee, Chinese Stomatological Association and respiratory and cardiology experts in diagnosis and treatment for CVD patients, and by systematically summarizing the relevant international guidelines and literature regarding the relationship between CVD and oral diseases and the diagnosis and treatment of dental patients with heart failure, hypertension and antithrombotic therapy. The consensus aims to provide, for the dental clinicians, the criteria on diagnosis and treatment of CVD in dental patients in China so as to reduce the risk and complications, and finally to improve the treatment levels of dental patients with CVD in China.

[Methylation of p16 gene and reduced expression of p16 protein in insulinoma associated with clinicopathological features]

Objective: To study the alterations of p16 gene and its expression in insulinoma and to correlate the findings with clinicopathological characteristics. Methods: Expression of p16 protein was detected in 72 insulinomas and 49 para-tumoral or normal pancreatic tissues by immunohistochemical staining. Genomic DNA was isolated from 32 tumor tissue and 17 paired pancreatic tissues and bisulfite-modified. Promoter methylation status of p16 gene was detected in 32 tumor tissue and 17 paired pancreatic tissues by methylation specific PCR. The findings were correlated with the clinicopathological features. Results: There were 30 males and 42 females in all 72 patients, aged (46.5±14.0) years. Loss or reduced expression of p16 protein was found in 42 of 72 insulinomas (58.3%) while loss or reduced expression of p16 was seen in only 34.7% (17/49) of para-tumoral or normal pancreatic tissues (χ²=6.52, P=0.011). Promoter methylation of p16 gene was found in 13 of 32 insulinomas (40.6%) and only 2 of 17 (11.8%) para-tumoral tissues (χ²=4.35, P=0.037). The expression of p16 protein in insulinoma was not associated with clinicopathological features such as gender, age, tumor size and tumor grade. Conclusions: Loss or reduced expression of p16 protein was found in insulinomas, and associated with p16 gene promoter methylation.

Integrating tumor mutational burden and transcriptome expression into prediction of immune checkpoint inhibitor response and prognosis of patients with colon cancer

Whether tumor mutational burden (TMB), which refers to the total number of somatic or acquired mutations per million bases in a particular region of the tumor genome, can serve as a predictive biomarker of immune checkpoint inhibitor (ICI) therapy for colon cancer remains unclear. Hereby, we retrospectively investigated the differentially expressed genes (DEGs) based on the level of TMB and tried to established a risk score model as a novel biomarker. The DNA mutation data were retrieved from the Masked Somatic Mutation in Genomic Data Commons data portal of the Cancer Genome Atlas, where the RNA sequencing data, clinical information, and survival outcomes of patients were downloaded. Patients with incomplete clinical information were excluded. The immune score and stromal score were calculated to investigate immune infiltration. The patients were grouped into TMB-high group and the TMB-low group based on the median value of TMB. An immune relevant gene set was obtained from the Immunology Database and Analysis Portal to identify immune-related DEGs. The Cox proportional hazard model and nomogram were applied to establish the risk model. In results: the TMB value was associated with age (p≤0.001), clinical stage (p≤0.001), N stage (p≤0.001), M stage (p=0.003), and immune score (p≤0.001). Twenty-nine immune-related DEGs were identified as enriched in immune response-related function or pathway and tumorigenesis signaling. Nine of 29 were determined to establish a riskScore model. The riskScore suggested a positive relationship with the TMB value (p=0.033), immune score (p≤0.001), and tumor immune dysfunction and exclusion (TIDE) (p=0.002) and presented an independent prognostic factor (p≤0.001, HR=1.04), which predicted the overall survival with good specificity. We concluded that the combination of TMB with transcriptome expression has a predictive and prognostic value for patients treated with ICIs.

[Meta analysis on acceptance rate of HIV pre-exposure prophylaxis among men who have sex with men in China]

Objective: To systematically evaluate the acceptance of pre-exposure prophylaxis (PrEP)among men who have sex with men (MSM) in China, so as to provide reference for the promotion of preventive drug use before human immunodeficiency virus exposure in China. Methods: By searching the databases of China national knowledge infrastructure, VIP database, Wanfan knowledge service platform, PubMed, Web of Science, Embase and The Cochrane Library with key words of "men who have sex with men" "pre-exposure prophylaxis" "PrEP" and "MSM". The literature on the willingness of Chinese MSM population to accept PrEP was systematically collected, and the data of the literature meeting the inclusion criteria were extracted for Meta analysis. Results: A total of 12 articles were selected in this study, including 6 articles in English and 6 in Chinese. The score of bias risk assessment of eligible articles was 14-18, which was more than 70% of the total score. The total number of samples was 11 269. The overall acceptance rate of PrEP was 0.77(95%CI:0.71-0.82). In subgroup analysis, the acceptance rates of different nationalities, marriage, household registration, age, education background, income, sexual orientation, sexual behavior and awareness of PrEP were statistically significant. Conclusion: In general, the acceptance rate of PrEP in MSM population is higher, but the awareness rate is low. There are differences in the acceptance rate among different groups.

[Comparison of early postoperative effects between anterior bladder and posterior bladder approaches in robotic assisted laparoscopic radical prostatectomy]

Objective: To examine the effect of robotic assisted laparoscopic radical prostatectomy with different approaches on early postoperative effects. Methods: Totally 44 patients (average age of 65.9 years, range: 46 to 81 years) underwent robotic assisted laparoscopic radical prostatectomy by a single operator at Department of Urology, Peking Union Medical Collage Hospital from March 2018 to March 2020 were retrospectively analyzed. The mean age was 65.9 years (range: 46 to 81 years), including 24 cases in the anterior bladder approach group (anterior approach group) and 20 cases in the posterior bladder approach group (posterior approach group). The preoperative clinical data, perioperative related data and postoperative urinary control recovery were compared between the two groups by t test, χ² test or Fisher exact test. Results: In terms of clinical data, there was no difference in age, prostate volume, preoperative prostate specific antigen and Gleason score(all P>0.05). There was no significant difference in operation time ((184±43) minutes vs. (193±42) minutes, t=-0.599, P=0.55), bleeding volume ((218±88) ml vs. (225±115) ml, t=-0.244, P=0.81), postoperative stage (T2/T3: 15/9 vs. 12/8, χ²=0.029, P=0.87) and positive rate of cutting edge (29.2% (7/24) vs. 30.0% (6/20), χ²=0.004, P=0.95). In terms of postoperative urinary control, patient rates who achieved urinary control immediately after extubation was significantly higher for the posterior approach group than the anterior approach group (30.0% (6/20) vs. 4.2% (1/24), P=0.04). There was no significant difference between two groups for those who achieved urinary control 3 months after operation (6 cases vs. 11 cases, P=0.06), 6 months after operation (20 cases vs. 19 cases, P=0.36) and those who achieved urinary control 12 months after operation (23 cases vs. 19 cases, P=1). Conclusion: For robotic assisted laparoscopic radical prostatectomy, the posterior approach does not prolong the operation time, does not increase the amount of bleeding, and improves the short-term postoperative urinary control.

Band-selective Holstein polaron in Luttinger liquid material A0.3MoO3 (A = K, Rb)

(Quasi-)one-dimensional systems exhibit various fascinating properties such as Luttinger liquid behavior, Peierls transition, novel topological phases, and the accommodation of unique quasiparticles (e.g., spinon, holon, and soliton, etc.). Here we study molybdenum blue bronze A_0.3MoO₃ (A = K, Rb), a canonical quasi-one-dimensional charge-density-wave material, using laser-based angle-resolved photoemission spectroscopy. Our experiment suggests that the normal phase of A_0.3MoO₃ is a prototypical Luttinger liquid, from which the charge-density-wave emerges with decreasing temperature. Prominently, we observe strong renormalizations of band dispersions, which are recognized as the spectral function of Holstein polaron derived from band-selective electron-phonon coupling in the system. We argue that the strong electron-phonon coupling plays an important role in electronic properties and the charge-density-wave transition in blue bronzes. Our results not only reconcile the long-standing heavy debates on the electronic properties of blue bronzes but also provide a rare platform to study interesting excitations in Luttinger liquid materials.

Direct Measurement of the Astrophysical ^{19}F(p,αγ)^{16}O Reaction in the Deepest Operational Underground Laboratory

Fluorine is one of the most interesting elements in nuclear astrophysics, where the ^{19}F(p,α)^{16}O reaction is of crucial importance for Galactic ^{19}F abundances and CNO cycle loss in first generation Population III stars. As a day-one campaign at the Jinping Underground Nuclear Astrophysics experimental facility, we report direct measurements of the essential ^{19}F(p,αγ)^{16}O reaction channel. The γ-ray yields were measured over E_{c.m.}=72.4-344  keV, covering the Gamow window; our energy of 72.4 keV is unprecedentedly low, reported here for the first time. The experiment was performed under the extremely low cosmic-ray-induced background environment of the China JinPing Underground Laboratory, one of the deepest underground laboratories in the world. The present low-energy S factors deviate significantly from previous theoretical predictions, and the uncertainties are significantly reduced. The thermonuclear ^{19}F(p,αγ)^{16}O reaction rate has been determined directly at the relevant astrophysical energies.

[Role of hepatic surgery in colorectal cancer multiple liver metastasis]

Colorectal cancer liver metastasis can be categorized as initially resectable and initially unresectable liver metastasis. Patients with initially resectable colorectal cancer liver metastases may benefit from hepatic surgery significantly,while those with initially unresectable metastases also have an opportunity to be treated radically by liver surgery after conversion therapy,so as to have a prolonged survival time. It is crucial to choose the right time and right way of surgical intervention. The timing depends on determination of tumor resectability,controlling of pre-operative systemic therapy and evaluation of liver function after systemic treatment. The selection of right way contains the election between synchronous operation and staged operation, resection margin and using of technologies such as laparoscope and associating liver partition and portal vein ligation for staged hepatectomy. This paper aims to explore the optimal timing for operation and the approaches of surgical method based on the research progress worldwide for prolonging the survival time of patients with colorectal cancer multiple liver metastases.

[Structuring process approach to laparoscopic anatomical liver central lobectomy for hepatocellular carcinoma]

Objective: To investigate the feasibility and oncological efficacy of structuring process approach to laparoscopic anatomical liver central lobectomy for hepatocellular carcinoma. Methods: The clinical data of 65 patients with hepatocellular carcinoma who underwent laparoscopic anatomical liver central lobectomy at the Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital from April 2017 to April 2021 was retrospectively analyzed. There were 39 males and 26 females,aged (M(Q_R)) 61.2 (29.5) years (range:25 to 80 years).The body mass index was (24.2±3.8) kg/m² (range:19.5 to 26.1 kg/m²) and the tumor diameter was (6.7±2.9)cm(range:3.4 to 10.5 cm).This structuring process approach was designed using a series of main vessels as the plane markers, along which liver transection was carried out. The perioperative indicators and early oncological efficacy were then analyzed. Results: All the procedures were successfully carried out laparoscopically. The operative time was (190.5±70.4) minutes (range:90 to 280 minutes). The blood loss was (370.6±120.8)ml(range:100 to 1 050 ml). No patient received blood transfusion or converted to laparotomy. Postoperative complications occurred in 8 cases(12.3%). Postoperative hospital stay was (7.5±2.5) days(range:5 to 18 days).There was no perioperative death and rehospitalization within 30 days. Pathological study showed all the operations to be R0 resections, the average surgical margin was (2.4±1.9)cm(range:0.5 to 3.1 cm).The tumor recurrence rate was 12.3% after 1 year follow-up. Conclusion: Structuring process approach to laparoscopic anatomical liver central lobectomy could be used to treat patients with hepatocellular carcinoma.

Protective effects of lycopene on mitochondrial oxidative injury and dysfunction in the liver of aflatoxin B1-exposed broilers

This study was conducted to investigate the effects of lycopene (LYC) on mitochondrial oxidative injury and dysfunction in the liver of aflatoxin B₁ (AFB₁)-exposed broilers. A total of 192 healthy 1-day-old male broilers were randomly divided into 3 groups with 8 replicates of 8 birds each. Birds in the 3 groups were fed basal diet (control), basal diet with 100 µg/kg AFB₁, and basal diet with 100 µg/kg AFB₁ and 200 mg/kg LYC, respectively. The experiment lasted 42 d. The results showed that AFB₁ decreased average daily body weight gain (ADG), average daily feed intake, and gain to feed ratio (G :F) compared to the control group, the LYC supplementation increased ADG and G/F compared to AFB₁ group (P < 0.05). Broilers in the AFB₁ group had lower mitochondrial glutathione (mGSH) concentration and glutathione peroxidase (GSH-Px), manganese superoxide dismutase (MnSOD), and thioredoxin reductase activities, and higher hydrogen peroxide (H₂O₂) and reactive oxygen species (ROS) concentrations than the control group (P < 0.05). The LYC increased mGSH concentration and GSH-Px and MnSOD activities, and decreased H₂O₂ and ROS concentrations compared to AFB₁ group (P < 0.05). Broilers fed the AFB₁ diet showed increased mitochondrial swelling and decreased adenosine triphosphate concentration than the control group, and LYC had opposite effects (P < 0.05). The AFB₁ decreased the activities of mitochondrial electron transfer chain (ETC) complexes I, II, III, and V, downregulated the mRNA expression levels of hepatic MnSOD, thioredoxin 2, thioredoxin reductase, peroxiredoxin-3, peroxisome proliferator-activated receptor γ coactivator 1α, nuclear respiratory factor 1, and mitochondrial transcription factor A compared with the control group (P < 0.05), and LYC increased activities of mitochondrial ETC complexes III and V, and upregulated mRNA expression levels of these genes in comparison to AFB₁ group (P < 0.05). In conclusion, the LYC protected broilers from AFB₁-induced liver mitochondrial oxidative injury and dysfunction by stimulating mitochondrial antioxidant capacity and maintaining mitochondrial biogenesis.

[Clinical application and research progress of balloon-occluded retrograde transvenous obliteration in the treatment of gastric varices with decompensated liver cirrhosis]

Gastric varices are one of the serious complications of liver cirrhotic portal hypertension. Balloon-occluded retrograde transvenous obliteration (BRTO), as an interventional treatment method, can effectively prevent and control gastroesophagel variceal bleeding. Simultaneously, it has an obvious effect in the treatment of hepatic encephalopathy and liver function improvement. This article reviews the clinical application and research progress of BRTO at home and abroad in recent years, with a view to provide reference for clinical treatment.

[Effect of simulated occlusal force on periodontal ligament stem cells of the deciduous teeth at different stages of root absorption]

Objective: To explore the related mechanisms of biological root resorption in decidual teeth by studying the biological effect of simulated occlusal force on the periodontal ligament stem cells (PDLSC) at different stages of root absorption. Methods: According to the tooth type and root absorption degree, healthy retained deciduous incisors and healthy first premolars that needed to be removed for orthodontic treatment were collected and divided into three groups with six teeth in each group: the deciduous unabsorbed group (UN group), the absorbed group (R group) and the permanent teeth group (P group). PDLSC was isolated from periodontal ligament and cultured. PDLSC of three groups were loaded with dynamic pressure of 0-45, 0-90, 0-135, 0-180, 0-225 and 0-270 kPa, respectively. The proliferation ability was detected by cell counting kit-8 (CCK-8) technique on day 1 to day 7, respectively. The apoptosis levels of PDLSC after loading with dynamic pressure of 0-45, 0-90, 0-135, 0-180 and 0-225 kPa were observed by the flow cytometry. The changes of microfilaments were observed by fibrous actin (F-actin) staining after the cytokeleton was subjected to dynamic pressure of 0-90 kPa. Results: PDLSC of three groups exhibited various proliferation abilities to dynamic pressure. The A values in the UN group and R group were significantly higher than those in the P group and the difference was statistically significant (P<0.05). However, there was no significant difference between the UN group and the R group (P>0.05). The A values of PDLSC in UN group and R group under dynamic pressures of 0-45, 0-90, 0-135 and 0-180 kPa had no statistical significance compared with the control group unloading dynamic pressure (P>0.05). However, under 0-225 and 0-270 kPa dynamic pressures, the A values at the day 3 to day 7 were statistically significant (P<0.05). The A values of PDLSC in P group under 0-45, 0-90, 0-135, 0-180 and 0-225 kPa dynamic pressures for 1 to 7 days were no statistically significant difference compared with the control group (P>0.05). The A value in P group under the 0-270 kPa was statistically significant only on day 3 (1.386±0.131) and day 5 to day 7 (1.728±0.226, 2.029±0.168 and 2.263±0.210, respectively)(P<0.05). The result of apoptosis showed that the A values of PDLSC in UN group, R group and P group were significantly increased under 0-90, 0-135, 0-180 kPa and above dynamic pressures, respectively (P<0.05) compared with the control group unloading dynamic pressure. Under 0-90 kPa dynamic pressure, F-actin fluorescence staining samples in three groups all showed green filaments which were arranged along the long axis of the cells in the R group and the P group, while some fibers in the UN group were closely arranged and promoted stress fiber assembly. Conclusions: The biological characteristics of PDLSC at different root absorption stages were changed when they were stimulated by mechanical stress, and PDLSC of the deciduous teeth at the root unabsorption stage were more sensitive to mechanical stress stimulation.

Parameterized Analysis of Craniocerebral Injury Caused by Fist

Abstract

Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with different force and to predict the risk of craniocerebral injury, in order to provide reference for actual medical protection and forensic identification. Methods The finite element model of fist was constructed by using DICOM data modeling method and related software, and the effective mass and speed of fist were used to represent the kinetic energy of fist, and combined with human finite element model THUMS 4.02, the characteristics of craniocerebral injury caused by frontal and lateral blows were parametrically simulated. Results The probability of direct death from a blow to the head was low, but as fist power increased, so did the risk of craniocerebral injury. The characteristics of craniocerebral injury were also significantly different with the different fist hitting head locations. When the frontal area was attacked, the maximum equivalent stress of skull was 122.40 MPa, while that of brain tissue was 4.31 kPa. When the temporal area was attacked, the maximum equivalent stress of skull was 71.53 MPa, while that of brain tissue was 7.09 kPa. Conclusion The characteristics and risks of skull fracture and brain tissue injury are different when different parts of the brain are hit by fist. When the frontal area is hit, the risk of skull fracture is significantly higher than when the temporal area is hit. The risk of brain tissue injury is the opposite. The position with the highest probability of skull fracture is generally the place where the skull is directly impacted, and with the conduction of stress waves, it will spread to other parts of the skull, while the position with the highest risk of brain tissue injury is not the place where the brain is directly impacted.

Inverse association between systemic immune-inflammation index and bone mineral density in postmenopausal women

OBJECTIVE

The aim of the present study was to investigate whether systemic immune-inflammation index (SII) and neutrophil-to-platelet ratio (NLR) were associated with bone mineral density (BMD) in postmenopausal women.

METHODS

In this cross-sectional study, we enrolled 413 postmenopausal women who never received menopause hormone therapy. The relationship between SII, NLR, and BMD was investigated by linear regression analysis.

RESULTS

Significant inverse association was observed between SII and BMD in postmenopausal women. The mean BMD in each quartile of SII level were 0.923, 0.914, 0.900, and 0.876 g/cm², respectively (p = .011). After adjusting for covariates, SII levels remained significantly associated with BMD (regression coefficients for quartiles 1-3 vs. quartile 4 were 0.035, 0.029, and 0.023, respectively; p for trend <.05). An inverse association was also found between NLR and BMD in postmenopausal women. However, there was no significant association between NLR and BMD after adjusting for covariates.

CONCLUSION

The quartile of SII was negatively associated with the mean BMD in postmenopausal women, independent of age, body mass index, sex hormone levels, and other factors. Therefore, SII can be used as a new predictor of bone loss in postmenopausal women.

Observation of topological superconductivity in a stoichiometric transition metal dichalcogenide 2M-WS2

Topological superconductors (TSCs) are unconventional superconductors with bulk superconducting gap and in-gap Majorana states on the boundary that may be used as topological qubits for quantum computation. Despite their importance in both fundamental research and applications, natural TSCs are very rare. Here, combining state of the art synchrotron and laser-based angle-resolved photoemission spectroscopy, we investigated a stoichiometric transition metal dichalcogenide (TMD), 2M-WS₂ with a superconducting transition temperature of 8.8 K (the highest among all TMDs in the natural form up to date) and observed distinctive topological surface states (TSSs). Furthermore, in the superconducting state, we found that the TSSs acquired a nodeless superconducting gap with similar magnitude as that of the bulk states. These discoveries not only evidence 2M-WS₂ as an intrinsic TSC without the need of sensitive composition tuning or sophisticated heterostructures fabrication, but also provide an ideal platform for device applications thanks to its van der Waals layered structure.

[Estimation of dietary salt intake in adult residents in Anhui province, 2019]

Objective: Based on the data of the baseline survey of hypertension and sodium intake monitoring in Anhui province in 2019, the salt intake in adult residents was estimated. Methods: Multi-stage stratified cluster random sampling was used to select participants aged 18-69 years, questionnaire survey and related measurements were conducted. Salt intake in participants with different characteristics were estimated with complex sample and linearization of Taylor series based on design and the correlation between salt intake and blood pressure, waist circumference and BMI were tested by linear regression. Results: A total of 1 500 participants were included. The overall salt intake was 9.14 g/d, which was 9.84 g/d in men and 8.47 g/d in women (P<0.05). The differences in salt intake across different subgroups were significant (P<0.05). Univariate linear regression analysis showed that salt intake was positively correlated with SBP, DBP, waist circumference and BMI (P<0.05), while multivariate linear regression analysis (adjusted for other factors) only showed a positive correlation between salt intake and BMI (β=0.053,95%CI: 0.028-0.078, P<0.05). Conclusion: The dietary salt intake in adult residents in Anhui was higher than WHO recommendation, suggesting that public health education need to be taken to reduce salt intake.

516 Impacts of Chronic Nausea and Vomiting on Daytime Sleepiness and Fatigue

Introduction

Chronic nausea and vomiting (CNV), common symptoms in patients with GI disorders like gastroparesis, can be a debilitating health problem with considerable impact on patients’ health-related quality of life during daytime. Yet, little is known about how CNV may impact on sleepiness and fatigue during the daytime. Our aim was to examine the impact of CNV on daytime sleepiness and fatigue based on the data from a longitudinal study.

Methods

Prospective longitudinal study with two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the US general population. Analyses included subjects participating to both waves (N=10,931). CNV was defined as episodes of nausea and vomiting occurring at least twice a month for at least 1 month (outside pregnancy). Logistic regression models were employed to determine whether CNV is a predictive variable for excessive sleepiness or fatigue.

Results

Out of all W1 participants, 9.8% (95% CI: 9.2%-10.4%) reported nausea only while 3% (95% CI: 2.7%-3.3%) reported CNV. In W2, 7.7% (95% CI: 7.2%-8.2%) reported nausea only and 2.5% (95% CI: 2.2%-2.8%) reported having CNV. Of the subjects who participated in both W1 and W2, 25.7% of them reported CNV in W1. CNV subjects reported more frequently excessive daytime sleepiness (53.5% vs. 25.9%) and being moderately or severely fatigued (38.6% vs, 5.4%) compared with the participants without nausea or vomiting. After controlling for age, sex, BMI, health status, alcohol intake, sleep disorders and psychiatric disorders that might impact on daytime sleepiness or fatigue, it was found that subjects with CNV at both W1 and W2 had a significantly higher relative risk of reporting daytime sleepiness (RR: 2.7 (95% CI:1.9–3.9) p&lt;0.0001) and fatigue (RR: 4.9 (95% CI:3.2–7.5) p&lt;0.0001) at W2, compared with the participants without nausea or vomiting.

Conclusion

Many factors are likely to influence daytime sleepiness. CNV appears to be an important contributor even after controlling for several factors that can explain the sleepiness. This underlines the extent to which alertness could be disturbed and impacted by chronicity of nausea/vomiting symptoms.

Support (if any)

This analysis study was funded by Takeda Pharmaceutical Company

[Changes of histopathological and hematological characteristics in recurrent chronic rhinosinusitis with nasal polyps]

Objective: To investigate the histopathological and hematological changes in reoperation of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: A total of 41 patients with CRSwNP who underwent two consecutive endoscopic sinus surgeries in Peking Union Medical College Hospital from February 1999 to April 2019 were included retrospectively, including 25 males and 16 females, aged (40.7±13.6) years at the former surgery and (47.0±13.2) years at the recurrent surgery. The peripheral blood cell count results were collected. Differential inflammatory cells in nasal polyp tissue sections were counted and characteristics of tissue remodeling were scored. Paired t test was used to compare the hematological and histological data of the two surgeries in the same cohort. Spearman's rank correlation coefficient was used to determine the correlation between tissue and peripheral blood eosinophil contents. Results: In histopathological tissue sections of nasal polyps, the mean tissue eosinophil, lymphocyte and total inflammatory cell counts per high power field significantly decreased (54.04±34.67 vs 76.97±65.59, 35.27±16.61 vs 50.01±26.94, 128.88±41.32 vs 176.38±80.59, t value was 2.413, 2.923, 3.445, respectively, all P<0.05), whereas the percentages of different inflammatory cell types remained unchanged when comparing the recurrent surgery with the former surgery. There was a significant reduction of basement membrane thickness and goblet cell hyperplasia score in the recurrent surgery (1.29±0.84 vs 2.00±0.84, 1.81±1.31 vs 2.44±1.10, t value was 5.367, 2.714, respectively, all P<0.05). Subgroup analysis suggested that changes in asthmatic cases, younger cases and cases without previous surgery were more remarkable than non-asthmatics, older cases and cases with previous surgery, respectively. There was no significant change in peripheral white blood cell counts and differential cell percentages, except a small increase of blood monocyte percentage. Correlation analysis showed that tissue eosinophil content correlated positively with blood eosinophil content at each surgery. Conclusions: In the recurrent surgery of CRSwNP, tissue eosinophil, lymphocyte and total inflammatory cell counts decrease significantly compare with that of the former surgery. The histological inflammatory load decreases with improvement of tissue remodeling, which could be attributed to the integrated treatment with surgery and medications.

[Research Status of Postmortem MSCT Angiography in Forensic Science]

Abstract

Virtual autopsy is a new technique for investigating the morphological changes of cadaveric tissues and organs by medical imaging technology. It has been widely used in the identification of causes of death. Multislice spiral computed tomography （MSCT） has become a routine inspection method in some identification institutions, although it cannot completely replace traditional autopsy, it plays a key auxiliary or substitute role in the identification of certain abnormal causes of death. Plain MSCT scan cannot visualize cadaveric vessels, but can perform cadaveric angiography to determine vascular injury or disease. This technology has entered a rapid development period in recent years, and has made a considerable progress in contrast agent, perfusion methods and imaging methods. This article summarizes several common cadaveric MSCT angiography methods, such as systemic angiography, angiography through cardiopulmonary resuscitation, targeted angiography, and angiography by cardiac puncture, and analyzes and compares the application prospects.