Association of serum 25-hydroxyvitamin d concentrations with all-cause and cause-specific mortality among individuals with depression: A cohort study

BACKGROUND

Limited evidence exists on the relationship between vitamin D status and mortality in depressed patients.

METHODS

This study investigates serum 25-hydroxyvitamin D [25(OH)D] concentrations in 8417 adults with depression among the National Health and Nutrition Examination Survey (NHANES, 2005-2018). Mortality outcomes were assessed through National Death Index records up to December 31, 2019. Cox proportional risk models estimated risk ratios (HR) and 95 % confidence intervals (CI) for all-cause, cardiovascular disease (CVD), and cancer mortality. Restricted cubic spline analyses explored the nonlinear association of serum 25(OH)D levels with mortality, using the likelihood ratio test for nonlinearity.

RESULTS

The weighted mean serum 25(OH)D level was 66.40 nmol/L (95 % CI: 65.8, 67.0), with 36.3 % having deficient vitamin D (<50 nmol/L [20 ng/mL]). Over an average 7.16-year follow-up, 935 deaths were documented, including 296 CVD deaths and 191 cancer deaths. Higher serum 25(OH)D levels were associated with reduced all-cause mortality (HRs 0.55-1.00, p trend = 0.006) and cancer-specific mortality (HRs 0.36-1.00, p trend = 0.015) after multivariate adjustment. The relationship between serum 25(OH)D and all-cause mortality exhibited a nonlinear pattern (P for nonlinearity <0.001), with a 34 % lower risk for each unit increase in natural log-transformed 25(OH)D levels. Significant interactions were observed with age, antidepressant use, and diabetes status.

CONCLUSIONS

Higher serum 25(OH)D levels were associated with decreased all-cause and cancer-specific mortality in depressed adults, particularly among younger individuals and those using antidepressants or without diabetes. Further research is essential to understand mechanisms and interventions related to vitamin D in depression.

B-Cell-Derived TGF-β1 Inhibits Osteogenesis and Contributes to Bone Loss in Periodontitis

B cells play a vital role in the elimination of periodontal pathogens, the regulation of the immune response, and the induction of tissue destruction. However, the role of B cells in the dysfunction of mesenchymal stem cell (MSC) differentiation to osteoblasts in periodontitis (PD) has been poorly studied. Here we show that the frequency of CD45^-CD105⁺CD73⁺ MSCs in inflamed periodontal tissues is significantly decreased in patients with PD compared with that of healthy controls. CD19⁺ B cells dominate the infiltrated immune cells in periodontal tissues of patients with PD. Besides, B-cell depletion therapy reduces the alveolar bone loss in a ligature-induced murine PD model. B cells from PD mice express a high level of TGF-β1 and inhibit osteoblast differentiation by upregulating p-Smad2/3 expression and downregulating Runx2 expression. The inhibitory effect of PD B cells on osteoblast differentiation is reduced by TGF-β1 neutralization or Smad2/3 inhibitor. Importantly, B-cell-specific knockout of TGF-β1 in PD mice significantly increases the number of CD45^-CD105⁺Sca1⁺ MSCs, ALP-positive osteoblast activity, and alveolar bone volume but decreases TRAP-positive osteoclast activity compared with that from control littermates. Lastly, CD19⁺CD27⁺CD38^- memory B cells dominate the B-cell infiltrates in periodontal tissues from both patients with PD and patients with PD after initial periodontal therapy. Memory B cells in periodontal tissues of patients with PD express a high level of TGF-β1 and inhibit MSC differentiation to osteoblasts. Thus, TGF-β1 produced by B cells may contribute to alveolar bone loss in periodontitis, in part, by suppressing osteoblast activity.

Structure-preserving visualization for single-cell RNA-Seq profiles using deep manifold transformation with batch-correction

Dimensionality reduction and visualization play an important role in biological data analysis, such as data interpretation of single-cell RNA sequences (scRNA-seq). It is desired to have a visualization method that can not only be applicable to various application scenarios, including cell clustering and trajectory inference, but also satisfy a variety of technical requirements, especially the ability to preserve inherent structure of data and handle with batch effects. However, no existing methods can accommodate these requirements in a unified framework. In this paper, we propose a general visualization method, deep visualization (DV), that possesses the ability to preserve inherent structure of data and handle batch effects and is applicable to a variety of datasets from different application domains and dataset scales. The method embeds a given dataset into a 2- or 3-dimensional visualization space, with either a Euclidean or hyperbolic metric depending on a specified task type with type static (at a time point) or dynamic (at a sequence of time points) scRNA-seq data, respectively. Specifically, DV learns a structure graph to describe the relationships between data samples, transforms the data into visualization space while preserving the geometric structure of the data and correcting batch effects in an end-to-end manner. The experimental results on nine datasets in complex tissue from human patients or animal development demonstrate the competitiveness of DV in discovering complex cellular relations, uncovering temporal trajectories, and addressing complex batch factors. We also provide a preliminary attempt to pre-train a DV model for visualization of new incoming data.

UDRN: Unified Dimensional Reduction Neural Network for feature selection and feature projection

Dimensional reduction (DR) maps high-dimensional data into a lower dimensions latent space with minimized defined optimization objectives. The two independent branches of DR are feature selection (FS) and feature projection (FP). FS focuses on selecting a critical subset of dimensions but risks destroying the data distribution (structure). On the other hand, FP combines all the input features into lower dimensions space, aiming to maintain the data structure, but lacks interpretability and sparsity. Moreover, FS and FP are traditionally incompatible categories and have not been unified into an amicable framework. Therefore, we consider that the ideal DR approach combines both FS and FP into a unified end-to-end manifold learning framework, simultaneously performing fundamental feature discovery while maintaining the intrinsic relationships between data samples in the latent space. This paper proposes a unified framework named Unified Dimensional Reduction Network (UDRN) to integrate FS and FP in an end-to-end way. Furthermore, a novel network framework is designed to implement FS and FP tasks separately using a stacked feature selection network and feature projection network. In addition, a stronger manifold assumption and a novel loss function are proposed. Furthermore, the loss function can leverage the priors of data augmentation to enhance the generalization ability of the proposed UDRN. Finally, comprehensive experimental results on four image and four biological datasets, including very high-dimensional data, demonstrate the advantages of DRN over existing methods (FS, FP, and FS&FP pipeline), especially in downstream tasks such as classification and visualization.

Relationship between depressive disorders and biochemical indicators in adult men and women

BACKGROUND

Depression is a psychiatric disorder with global public health concerns. Although a number of risk factors have been identified for depression, there is no clear relationship between biochemistry and depression. In this study, we assessed whether depressive disorders are significantly associated with biochemical indicators.

METHODS

Our study included 17,561 adults (age ≥ 18 years) participating in the 2009-2018 National Health and Nutrition Examination Survey (NHANES). The relationship between depression and biochemical and obesity indicators was analyzed by logistic regression.

RESULTS

As compared to the control group, men with depression showed significantly higher levels of gamma-glutamyl transferase, glucose, and triglycerides, and lower levels of albumin and total bilirubin. The depressed group had higher levels of alkaline phosphatase, bicarbonate, and sodium than the control group.

CONCLUSION

Several biochemical and anthropometric indices were associated with depression in this study. It would be interesting to further analyze their cause-effect relationship.

LIMITATIONS

This study is a cross-sectional study. The population is less restricted and does not exclude people with diabetes, pregnancy, etc., so it is less significant for a specific population. Dietary information was not included, as diet plays an important role in many indicators.

Development and validation of a novel M1 macrophage-related gene prognostic signature for lung cancer

Background

Lung cancer (LC) is the most common cancer. Using data from The Cancer Genome Atlas (TCGA), we analyzed the functional roles of M1 macrophage status in LC patients.

Methods

Clinical and transcriptome data of LC patients were obtained from the TCGA dataset. We identified M1 macrophage-related genes in LC patients and investigated the underlying molecular mechanisms of these genes in LC patients. After performing a least absolute shrinkage and selection operator (LASSO) Cox regression analysis, the LC patients were divided into two subtypes, and the underlying mechanism of the association between them was further explored. A comparison of immune infiltration was conducted between the two subtypes. Based on gene set enrichment analysis (GSEA), the key regulators associated with subtypes were further explored.

Results

M1 macrophage-related genes were identified using TCGA data, and these genes might be related to the activation of the immune response and cytokine-mediated signaling pathways in LC. A seven M1 macrophage-related gene signature (including STAT1, TAP1, UBE2L6, TAP2, CXCR6, PSMB8 and CD2) was identified in LC using LASSO Cox regression analysis. Two subtypes (low risk and high risk) of LC patients were created based on the seven M1 macrophage-related gene signature. Univariate and multivariate survival analyses further confirmed that the subtype classification was an effective independent prognostic factor. Moreover, the two subtypes were correlated with immune infiltration, and GSEA revealed that the pathways of tumor cell proliferation and immune-related biological processes (BPs) might play an important role in LC in the high-risk group and low-risk group, respectively.

Conclusions

M1 macrophage-related subtypes of LC were identified and were closely associated with immune infiltration. The gene signature involved in M1 macrophage-related genes could help make a distinction and predict prognosis for LC patients.

Association between serum calcium and in-hospital mortality in critical patients with multiple myeloma: a cohort study

BACKGROUND

Elevated serum calcium levels may serve as a useful clinical biomarker of mortality in patients with multiple myeloma(MM). However, the clinical significance of the relationship between serum calcium levels and in-hospital mortality in MM patients admitted to the Intensive Care Unit (ICU) remains unclear.

OBJECTIVES

This study aimed to explore the association between serum calcium levels and in-hospital mortality in patients with MM in the ICU.

METHODS

Patients with MM were identified from the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. The outcome was in-hospital mortality. Multivariable-adjusted Cox regression analysis, curve fitting, and threshold effects analysis were used to assess the relationship between serum calcium levels and in-hospital mortality in patients with MM in the ICU.

RESULTS

Our study included 262 patients with MM with a mean age of 72.3 ± 11.0 years, 63.4% of whom were male. The in-hospital mortality was 19.5% (51/262). The relationship between serum calcium levels and in-hospital mortality was nonlinear. The effect size on the left and right sides of the inflection point, were 0.270 (HR: 0.270, 95% CI 0.106-0.687, P < 0.05) and 2.104 (HR: 2.104, 95% CI 1.069-4.142, P < 0.05), respectively. The results of the sensitivity analysis remained stable.

CONCLUSION

Our findings show that a nonlinear relationship exists between serum calcium levels and in-hospital mortality in critically ill patients with MM. A serum calcium level of approximately 8.40 mg/dL was associated with the lowest risk of in-hospital mortality, which increases with rising serum calcium levels, and should be of concern to ICU physicians.

Association Between Dietary Fiber Intake and Risk of Depression in Patients With or Without Type 2 Diabetes

BACKGROUND

Depression and type 2 diabetes (T2D) are both serious public health problems, with morbidity and mortality in people increasing year by year, resulting in a heavy economic burden. A correlation between dietary fiber and both has been reported. Nevertheless, few data are available concerning dietary fiber and the risk of depression with or without T2D, which deserve further attention.

MATERIALS AND METHODS

We assessed the relationship between dietary fiber intake and risk of depression with or without T2D in the 2007-2014 National Health and Nutrition Examination Survey (NHANES) population. A 24-h dietary review was used to assess fiber intake. The Patient Health Questionnaire-9 was used to assess depression. Stability of the results was assessed using restricted cubic spline models and logistic regression, as well as sensitivity analyses.

RESULTS

A total of 17,866 adults aged 20 years and older with a mean age of 49.3 ± 17.7 years were included in this study, of whom 49.5% were male. After adjusting for covariates, the association of dietary fiber intake with the risk of depression appeared to differ between non-T2D group and T2D group (OR, 0.987; 95% CI, 0.979-0.995 vs. OR, 1.003; 95% CI, 0.988-1.017). Furthermore, when dietary fiber was converted to a categorical variable, there was evidence of interaction between T2D status and fiber intake on decreasing the prevalence of depression (P-value for interaction = 0.015). Sensitivity analysis showed stable results.

CONCLUSION

Our findings indicated that whether a patient has T2D may affect the relationship between dietary fiber intake and the risk of depression, which still needs to be confirmed by further randomized controlled trials.

Inherited and acquired causes renal vein thrombosis in an 11-year-old boy who was relieved after piperacillin-tazobactam and rivaroxaban treatment: a case report

BACKGROUND

Physiological hypercoagulability is a well-known condition in older populations, whereas thrombosis, especially in renal veins, is a rare occurrence in teenagers. This paper presents a pediatric case of renal venous infarction and thrombosis.

CASE DESCRIPTION

We report the case of an 11-year-old Chinese boy who presented with low back discomfort and was afraid to walk. Computed tomography (CT) revealed thrombosis in his renal veins and inferior vena cava. He was being treated for severe refractory mycoplasma pneumoniae pneumonia (MPP). He was treated with rivaroxaban and urokinase for thrombosis, and azithromycin for MPP. On day 2 after admission, his symptoms improved. Therefore, the dosage of rivaroxaban was decreased from 10 to 5 mg twice per day. On day 3 after admission, enhanced CT revealed new thromboses in the bilateral pulmonary trunks and arteries, inferior cava, right renal veins, bilateral common iliac veins, and internal iliac vein. The ultrasonography showed a strip hypoecho at the pulmonary artery bifurcation. All the above imaging suggested that antithrombotic therapy was insufficient. His plasma antithrombin (AT) III activity remained consistently low during hospitalization. The family history was re-examined and revealed that both his father and grandfather had experienced spontaneous pulmonary thrombosis around the age of 30. He was diagnosed with acquired and inherited thrombosis and inherited AT III deficiency. Following a medication regimen of piperacillin-tazobactam for 1 week and rivaroxaban (10 mg, twice daily), he was discharged and no thrombosis and other side effects or complications occurred in the following 3 months.

CONCLUSIONS

This is a rare case of a teenager with inherited and acquired hypercoagulability. For refractory MPP pediatric patients with thrombosis, clinicians should consider whether hereditary factors, such as inherited AT III deficiency, are involved in thrombosis.

AB0171 TOWARDS A BETTER IMPLEMENTATION OF TREAT-TO-TARGET STRATEGY IN RHEUMATOID ARTHRITIS: A COMPARISON OF TWO REAL-WORLD COHORTS

Background

Treat-to-target (T2T) strategy has been the core of rheumatoid arthritis (RA) management for over a decade, however implemented distinctly varied in real practices.

Objectives

We tried to investigate the differences in disease activity and target achievement of two cohorts with different T2T implementations.

Methods

We used data of the CENTRA (Collaboratively intENsive Treat-to-target in RA) and TARRA (Treat-to-TARget in RA) cohorts. The CENTRA is a RA cohort prospectively follow-up by a fixed team with tight control, while the TARRA is a longitudinal observational cohort follow-up by a rheumatologist with casual control. Patients from two cohorts were matched 1:3 by propensity score matching (PSM). The primary outcome was simplified disease activity index (SDAI) at 1-year follow-up.

Results

102 patients from the CENTRA cohort and 271 patients from the TARRA cohort were included. Both groups were comparable in terms of age, gender, disease course, and seropositivity. At the end of 1 year follow-up, the SDAI of patients in the CENTRA cohort was significantly lower than that of patients in the TARRA cohort (2.1 vs 3.4, p＜0.001). The follow-up interval of patients in the CENTRA cohort was significantly shorter than that in the TARRA cohort when patients have not achieved remission (3.1 vs. 3.3 months, p=0.019).

Conclusion

RA patients may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with a casual T2T strategy.

Disclosure of Interests

None declared

POS0599 IMPACT OF TREAT-TO-TARGET THERAPY ON BONE MINERAL DENSITY LOSS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A PROSPECTIVE COHORT STUDY

Background

Osteoporosis is a common comorbidity of rheumatoid arthritis (RA). Although RA disease activity has been demonstrated to be associated with bone loss in previous studies, most of them were cross-sectional studies and not in the context of treat-to-target (T2T) strategies.

Objectives

To evaluate the association of disease activity with bone mineral density (BMD) changes in the context of T2T strategies in a prospective RA cohort.

Methods

RA patients were enrolled from a prospective CENTRA cohort of Peking University First Hospital. BMD was repeated at baseline, 1-year and then every other year. Time-adjusted mean disease activity scores were adopted to reflect the overall disease activity during follow-up. The influence of univariable associations between predictors and BMD was investigated using linear regression.

Results

A total of 268 patients were included in our analysis. Their mean age was 50 (12.9) years old. At enrollment, the mean (SD) DAS28-ESR was 3.70 (1.17), and the median (IQR) CDAI and SDIA was 10 (14.45) and 10.30 (16.53), respectively. Osteoporosis at lumbar spine was observed in 23.1% patients and 9.3% at femoral neck at enrollment. Older age, higher SDAI score and lower BMI were found to be associated with osteoporosis at baseline. Reevaluations of BMD at 1 year was applied in 144 patients. Mean decreases of BMDs were 1.75 % at the lumbar spine and 1.40 % at femoral neck at 1 year form baseline, respectively. Patients who achieved remission had less yearly bone loss at lumbar spine (p=0.036). Female gender was identified as a risk factor in the multiple linear regression analyses, and lower disease activity and bisphosphonates were protective factors of continuous bone loss.

Conclusion

Disease activity is associated with bone loss in RA patients in the context of T2T strategies, and those who achieved remission had less yearly bone loss.

Disclosure of Interests

None declared

POS0315 DIAGNOSTIC PERFORMANCE OF CASPAR CRITERIA FOR PSORIATIC ARTHRITIS WITH OR WITHOUT INTEGRATION OF ULTRASOUND

Background

Although the CASPAR criteria in the diagnosis of psoriatic arthritis (PsA) have been validated, CASPAR based on physical examination (PE) is not “gold standard”. The ultrasound (US) could improve the diagnostic accuracy as compared to clinical examination alone.

Objectives

To evaluate the diagnostic performance of CASPAR criteria for psoriatic arthritis (PsA) with or without integration of ultrasound (US).

Methods

The patients with hint of PsA were enrolled. Tender and swollen joint counts, presents of enthesitis and dactylitis were collected by physical examination (PE). US was performed to evaluate peripheral joints, entheses and tendons. The additional value of US to CASPAR criteria were analysed.

Results

326 consecutive patients were enrolled, with 164 PsA and 162 non-PsA. Significantly higher frequencies of tenosynovitis and enthesitis on US and new bone formation on X-ray were found in PsA than non-PsA patients (56.7% vs. 13.0%; 62.2% vs. 14.2%; 62.2% vs. 8.0%, p<0.01 for all). Logistic regression analysis showed that dactylitis (OR=12.0, p<0.01), family history of PsO/PsA (OR=3.1, p<0.05), nail involvement (OR=3.5, p=0.01), new bone formation (OR=14.8, p<0.01) and tenosynovitis on US (OR=21.3, p<0.01), enthesitis on US (OR=21.7, p<0.01) were independent risk factors for PsA. Adding US tenosynovitis and/or enthesitis to CASPAR criteria showed better performance by improving the specificity (91.4% vs. 67.9%) and meanwhile keeping sensitivity (92.1% vs. 96.3%). When replacing hand X-ray by US in CASPAR criteria, the sensitivity and specificity were comparable to CASPAR criteria adding with US. The diagnostic accuracy was 82.2% for CASPAR criteria based on PE, 91.7% for CASPAR integrated with US, and 91.4% for CASPAR with US to replace X-ray.

Conclusion

CASPAR criteria based on US improve the diagnosis utility of PsA than CASPAR criteria based on PE. US assessment is valuable in the diagnosis of PsA.

References

[1]Fiorenza A, Bonitta G, Gerratana E, et al. Assessment of enthesis in patients with psoriatic arthritis and fibromyalgia using clinical examination and ultrasound. Clinical and experimental rheumatology 2020;38 Suppl 123:31-9.

[2]Zabotti A, Bandinelli F, Batticciotto A, et al. Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 2017;56:1518-32.

Figure 1.

ROC curves for adding US or substituting X-ray by US in CASPAR criteria. Receiver operating characteristic (ROC) curve illustrates the diagnosis performance of CASPAR criteria adding US or substituting X-ray by US in CASPAR criteria and CASPAR criteria based on PE alone. The area under the curve of the ROC curve (AUC) was 0.929 (95%CI 0.897, 0.961) (p<0.01) for adding US to CASPAR criteria. AUC was 0.908 (95%CI 0.876, 0.940) (p<0.01) for CASPAR criteria based on PE. And AUC was 0.916 (95%CI 0.880, 0.951) (p<0.01) for substituting X-ray by US in CASPAR criteria. CASPAR: ClASsification criteria for Psoriatic ARthritis; PE: physical examination; US: ultrasound.

Disclosure of Interests

None declared

Iodine-125 brachytherapy for the treatment of central mucoepidermoid carcinoma of the jaw in a pre-teen

Central mucoepidermoid carcinoma (MEC) of the jaw is a rare malignant neoplasm, even rarer in teenagers. Radical surgical resection, such as en bloc resection or segmental resection, is the main treatment for MEC of the jaw. This surgical treatment results in a loss of integrity of the jaw. The successful application of iodine-125 brachytherapy for the treatment of intraosseous MEC of the mandible in an 11-year-old girl is reported here. No local recurrence or distant metastasis was observed during 6 years of follow-up. The integrity of the mandible was preserved and the development of the mandible was not significantly affected. Iodine-125 brachytherapy is a potential alternative treatment for central mucoepidermoid carcinoma of the jaw, especially in teenagers, and may preserve the continuity and function of the jaw.

[Analysis of molecular and clinical characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in the intensive care unit]

To investigate the carbapenemases distribution of carbapenem-resistant Klebsiella pneumoniae (CRKP) in the intensive care unit, and the clinical characteristics between carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) and carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP) were compared. A total of 53 non-repetitive CRKP strains isolated from 49 patients in the intensive care unit of the Second Affiliated Hospital of Xi'an Jiaotong University from May 2020 to March 2021 were retrospectively studied. The carbapenemase inhibitor enhancement test was used for screening carbapenemase-producing strains, and the string test was carried out to screen the hypermucoviscosity phenotype. Using PCR to detect five main carbapenemase genes (bla_KPC-2, bla_NDM, bla_IMP , bla_VIM and bla_OXA-48-like), common serotype (K1 and K2) and virulence gene (rmpA and iutA). Treated the strains with both rmpA and iutA genes as hypervirulent Klebsiella pneumonia (hvKP), and the whole genome sequencing of CR-hvKP was completed. At the same time, the clinical data of 49 patients were sorted out, and the differences in clinical characteristics of CR-hvKP and CR-non-hvKP infected patients were compared using the independent sample t test, Mann-Whitney U test, chi-square test or Fisher's exact probability test. CRKP isolated from the intensive care unit were extensively drug resistance and still had a good sensitivity to polymyxin B and tigecycline. Producing carbapenemases were the main resistance mechanism of CRKP (52/53, 98.1%). Of the 53 CRKP strains, except for 1strain that did not detect carbapenemase, at least one carbapenemase resistance gene was detected in the remaining 52 CRKP strains, of which 45 strains carried an enzyme, including 36 bla_KPC-2 (36/53, 67.9%), 8 bla_NDM (8/53, 15.1%), 1 bla_IMP (1/53, 1.9%), and 7 strains carried with both bla_KPC-2 and bla_NDM (7/53, 13.2%). String test and virulence gene showed that 7 CR-hvKP strains (13.2%) were detected in 53 CRKP strains, and two of which were hypermucoviscosity phenotype. Sequencing results revealed that CR-hvKP were mainly ST11 type. Almost all patients with CR-hvKP infection were over 60 years old (7/7), with invasive treatment (7/7), pulmonary infection with hypermucoviscosity phenotype (2/7) and high mortality (5/7); and the percentage of neutrophils in patients with CR-hvKP infection (86.44±4.70) % was higher than those patients with CR-non-hvKP infection (78.90±19.15) %, the difference was statistically significant (t=-2.225, P=0.032). The CR-hvKP strains in the intensive care unit mainly produced KPC-2 enzyme, with K2 capsular serotype and ST11 type. It is necessary to strengthen the monitoring and control of the CR-hvKP strain to prevent the co-evolution of drug-resistant and hypervirulent strains.

[The standardized diagnosis and treatment of rheumatoid arthritis]

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation of the joints with high risk of disability. In recent years, remarkable progress has been made towards the diagnosis and treatment of RA, and the international RA guidelines have been also kept updated. Nevertheless, there are many challenges in China, especially inadequate number of rheumatologists and insufficient experience in the diagnosis and treatment of RA. Therefore, Chinese Rheumatology Association drafted the standardized diagnosis and treatment of RA based on the available evidence, so as to improve the management of RA patients in China.

Associations between urea nitrogen and risk of depression among subjects with and without type 2 diabetes: A nationwide population-based study

BACKGROUND

Depression and type 2 diabetes (T2D) are serious public health problems with irreversible health consequences and a significant economic burden on the healthcare system. Previous studies have suggested that blood urea nitrogen (BUN) was inversely longitudinally associated with incidence of diabetes and depression in adults, but few well-designed studies have examined the effects of status of T2D on the full range of relationship between BUN and depression.

METHODS

The analysis sample consisted of adults aged≥20 years from the 2007-2014 National Health and Nutrition Examination Survey (NHANES) who completed the Patient Health Questionnaire-9 (PHQ-9), involving 19,005 participants. By stratifying participants according to T2D status, we further assessed the difference between BUN and risk of depression in participants with and without T2D using multivariate logistic regression (interaction test).

RESULTS

In this cross-sectional study, the association between BUN and depression prevalence appeared to differ between the T2D and non-T2D groups (OR: 1.00, 95% Cl: 0.95-1.05 vs. OR: 0.89, 95% Cl: 0.85-0.93). In addition, there was evidence of an interaction between BUN levels and T2D status in reducing the risk of depression (P value for interaction = 0.032.) The relationship between BUN and depressive symptoms was significant in non-T2D subjects (P < 0.001), but not in T2D (P = 0.940).

CONCLUSIONS

Our findings suggest that there is a significant relationship between BUN and depression, and T2D status may influence the association between BUN and the risk of depression. Such findings require further prospective studies to provide more evidence.

Negative anti-neutrophil cytoplasmic antibodies and eosinophilic granulomatosis with polyangiitis accompanied by cough variant asthma: a case report

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a rare chronic necrotizing eosinophilic granulomatous inflammatory disease characterized by eosinophil-rich granulomatous inflammation and small- to medium-size vessel vasculitis associated with bronchial asthma and eosinophilia, which is positive for anti-neutrophil cytoplasmic antibody (ANCA) in approximately 50-70% of cases. We report a case of a 23-year-old woman was admitted to our hospital because of a of small vesicles on both lower limbs and a 4-month history of small scattered skin rash with pruritus V6 on both lower limbs four-month history of scattered skin rash with pruritus. Laboratory data from peripheral blood revealed leukocytosis, eosinophilia, thrombocytosis, hyperfibrinolysis, and mild renal injury. Her ANCA was negative, and the skin pathological examination showed granuloma lesions with eosinophils, while elevated eosinophils were also found in the bone marrow. EGPA was diagnosed. On the other hand, the patient had 2-year-long rhinosinusitis, 9-month-long nephrotic syndrome, and 1-month-long dry cough, which might be a type of asthma. With steroid therapy followed by systemic immunomodulatory therapy, the patient's symptoms were relieved. Our case report and literature review highlight the importance of recognizing cough variant asthma as an initial presenting symptom of EGPA, providing an opportunity for early diagnosis and treatment to reduce the risk of further disease progression and morbidity.

Factors Associated with Age-Related Changes in Non-Smoking Urban Men and Women in China Determined by Low-Dose Computed Tomography Imaging

Background

Respiratory function usually worsens in the elderly with aging. This study aimed to retrospectively investigate tracheal changes caused by “normal aging” through use of low-dose CT (LDCT) in non-smoking asymptomatic urban residents and the related factors influencing tracheal changes.

Material/Methods

A total of 733 Chinese subjects who underwent LDCT were recruited. The trachea shape, width, and calcification degree of the tracheal wall were measured and compared between males and females and among different age groups. The effects of age, sex, trachea morphology, BMI, BP, GLU, TC, TG, HDL, and LDL on the width and calcification of tracheal wall were analyzed by multiple linear regression.

Results

Significant sex differences in trachea shape were found, as type II and type I were found mainly in the males and females, respectively. The values of anterior-posterior inner diameter (AP), left-right inner diameter (LR), width, and calcification score of tracheae in the males were higher than that in the females. In both males and females, trachea AP, wall width, and calcification scores increased with age, but this trend was not observed in tracheal LR. Age, sex, and trachea shape had significant effects on the width and calcification scores of tracheal walls, and trachea calcification was one of the factors influencing tracheal wall width.

Conclusions

Tracheal aging can be evaluated by measuring trachea shape, thickness, and the degree of calcification of the tracheal wall by LDCT, while sex and age should be taken into consideration comprehensively for judging normal trachea aging. In addition, obesity may aggravate trachea aging.

Anti-beta 2 glycoprotein 1 domain IgA positive antiphospholipid syndrome secondary to incomplete Behcet's disease: a case report

Antiphospholipid syndrome (APS) is an autoimmune systemic disorder characterized by arterial, venous, or small vessel thrombosis, and/or recurrent early pregnancy loss, fetal loss, or pregnancy morbidity. APS is induced by persistent positive antiphospholipid antibodies (aPL), the main being lupus anticoagulant (LA), and/or anticardiolipin (aCL) antibodies, and/or anti-beta 2 glycoprotein 1 (β2-GP1) antibodies. Some studies have shown that the incidence of APS is about 5 new cases per 100,000 persons per year, and the prevalence is around 40-50 cases per 100,000 persons. APS can be primary or secondary. Secondary APS often coexists with another autoimmune disorder, most commonly systemic lupus erythematosus (SLE). Behcet's disease (BD) is usually characterized by recurrent oral and genital aphthous ulcers and ocular involvement. It can occasionally affect the venous system. BD usually affects small vessels, but can sometimes affect large veins or even a variety of veins. Because most of APS is secondary to SLE, APS secondary to incomplete BD is quite rare. This report describes a case in which a 15-year-old male experienced bilateral leg swelling and pain. The patient had a long history of self-healing recurrent mouth ulcers. Laboratory tests revealed positive β2-GP1 immunoglobulin A (IgA). His symptoms improved by using steroids, prednisolone, uro-kinase, and hirudin. In this rare case of secondary APS, the patient was diagnosed with anti-β2-GP-1 IgA positive to incomplete BD. It is a rare case of secondary APS with positive anti-β2-GP1 IgA to incomplete BD. It is suggested that patients with recurrent mouth ulcers should be closely examined to prevent thrombosis, and more laboratory markers should be used to avoid a risk of misdiagnosing patients with APS.

AB0280 THE INFLUENCE OF TARGET THERAPY AS WELL AS GLUCOCORTICOIDS TAPERING ON DISEASE FLARE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT

Background:

Treat-to-target in systemic lupus erythematosus (SLE) has been proposed for 7 years and several recommendations were developed [1]. In these recommendations, prevention of flares should be a realistic target. Meanwhile, ‘remission’ or ‘low disease activity’ was recommended as the treatment target and minimizing glucocorticoids (GC) dose or withdrawal if possible was suggested in the maintenance treatment. However, would target therapy and GC tapering/withdrawal influence disease flare?

Objectives:

To investigate the frequency and determinants of disease flare, especially the influence of target therapy as well as GC tapering on flare in Chinese lupus patients.

Methods:

The baseline and follow-up data of all consecutive patients in a prospective longitudinal lupus cohort from January 2017 to June 2020 were collected. The lupus low disease activity state (LLDAS) was defined as in Golder et al., 2019[2]. The criteria for remission were from DORIS definitions [3]. Flare was assessed using the SELENA-SLEDAI flare index [4].

Results:

We enrolled 185 patients with disease duration at recruitment of 2.3 (0.8–7.7) years. During the 26.2 (12.5-34.5) months of follow-up, 73 (39.5%) patients experienced 95 flares, including 70 mild/moderate and 25 severe flares. The incidence of flare per patient-year was 0.27. Kaplan-Meier analyses showed that compared with those who never achieved LLDAS or DORIS, the patients who achieved the target at least once had a higher flare free survival rate; meanwhile, the patients with prednisone withdrawn had significantly lower flare free rate compared with those with small dose of GC maintained (≤7.5mg/d) (Figure 1A), but among the patients with different prednisone maintain doses (7.5~5mg, 5~2.5mg, and ≤2.5mg) there was not significant difference (Figure 1B). Cox regression analysis showed that younger age at disease onset and lower Complement 3 (C3) level at recruitment were independent risk factors for flare and achieving LLDAS or DORIS ≥50% of visits was independent protective factor (Table 1).

Conclusion:

In this Chinese prospective SLE cohort, age at disease onset, C3 level at recruitment and therapeutic target achieving influenced disease flare independently and significantly. GC tapering in appropriate patients and with appropriate pace did not increase the flare rate, but prednisone withdrawal may induce more disease exacerbation, which needs to be confirmed by large prospective studies.

References:

[1]Van Vollenhoven R F, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis, 2014. 73(6): 958-967

[2]Golder, V., et al. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102.

[3]van Vollenhoven R, et al. A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Ann Rheum Dis. 2017. 76(3): 554–561.

[4]Petri M, et al. Classification and definition of major flares in SLE clinical trials. Lupus. 1999. 8(8): 685-691.

Table 1.

Determinants of disease flare by multivariate Cox regression analyses

Model 1(LLDAS) ΔModel 2(RONT) ΔModel 3(Complete RONT) ΔHR95%CIP valueHR95%CIP valueHR95%CIP valueAge at disease onset (years)†0.970.95-0.990.0040.970.95-0.990.0030.970.95-0.990.003Anti-dsDNA positive at recruitment1.340.82-2.180.2171.120.68-1.850.6491.190.73-1.960.486C3 (mg/L) at recruitment0.9980.997-0.9990.0040.9980.997-0.9990.0070.9980.997-1.0000.010Minimum prednisone dose during follow- up (mg/d)0.980.90-1.080.7161.010.94-1.080.7471.040.97-1.110.243Therapeutic target achieved≥50% of observationsΔ0.600.39-0.940.0010.540.34-0.870.0110.680.51-0.920.011

Δ In the three hazard models, the different target achievement status were included respectively.

RONT: Clinical remission on treatment; Complete RONT: Complete remission on treatment.

Disclosure of Interests:

None declared

Herpes zoster recurrence within 1 month: A case report

Herpes zoster (HZ), caused by the varicella-zoster virus, is an infectious skin disease that rarely recurs after initial presentation. The mechanism underlying HZ recurrence is currently under investigation. In this article, we report a case of HZ relapse within 1 month. Analysis of patient’s clinical manifestations, histopathological features, and flow cytometry results indicated that the absolute and percentage values of B cells were below the lower limit. We hypothesized that the patient had abnormal humoral immune function, which may be one reason leading to the HZ relapse within 1 month. The findings of this case will serve as useful reference for HZ recurrence for clinicians. This case was impactful and added to the literature on HZ recurrence.

[Association between parental education level and left ventricular hypertrophy in childhood]

Objective: To examine the relationship between parental education level and left ventricular hypertrophy (LVH) in children. Methods: The data comes from the baseline survey of the Huantai Childhood Cardiovascular Health Cohort Study (HCCH) conducted in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to select a primary school in Huantai County, Zibo City, Shandong Province as a survey point. A cross-sectional survey was conducted from November 2017 to January 2018. A total of 1 316 children aged 6-11 years with complete data were included. LVH was defined as left ventricular mass index ≥ sex-and age-specific 90th percentile values of this population. Education levels of both parents were divided into junior high school or lower, high school, university or higher, respectively. Logistic regression models were used to analyze the association between parental education level and LVH in children. Results: The age of 1 316 participants was (8.9±1.5) years old. Among them, there were 703 boys (53.4%).After adjusting for gender, age, intake of vegetables and fruits, intake of carbonated drinks, physical activity, sleep time, screen time, overweight or obesity, and occasional hypertension, the logistic regression model results show that compared with those children whose parents' education level is junior high school or below, paternal or maternal education level of college or higher was associated with odds of LVH (father: OR=0.53, 95%CI: 0.33-0.87; mother: OR=0.52, 95%CI: 0.32-0.87; father/mother: OR=0.54,95%CI: 0.32-0.91). Conclusion: Parental education level is inversely associated with LVH in childhood. The probability of LVH in childhood decreases with the increase of parental education levels.

[The mechanism of hyperbaric oxygen regulating HMGB1 in the prevention and treatment of encephalopathy after acute CO poisoning]

Objective: To study the expression of high mobility group protein 1 (HMGB1) in the brain of rats after hyperbaric oxygen (HBO) treatment of acute carbon monoxide poisoning (DEACMP) , and to explore the mechanism of HBO in the prevention and treatment of DEACMP pathological process by regulating HMGB1. Methods: 108 SD rats were randomly divided into control group (NC group) and co group (CO group) . HBO treatment group (HBO group) , 48 rats in each group. Co group and HBO group were used to establish CO poisoning model, HBO group were treated with hyperbaric oxygen once a day. Water maze test was used to detect and analyze the memory retention ability of three groups of rats in 3 d, 7 d, 14 d. ELISA was used to detect the plasma concentration of HMGB1、IL-6、TNF-α in three groups of rats on the 1 d, 3 d, 7 d, 14 d, 21 d Concentration. Western blotting was used to detect the expression of HMGB1 and Caspase-3 in the brain of the three groups on the 1 d, 3 d, 7 d, 14 d, 21 d. TUNEL staining was used to detect the apoptosis of hippocampal neurons in the three groups. Results: Compared with NC group, the average escape latency of rats in CO group and HBO group was significantly prolonged, and the activity time of platform quadrant in CO group was significantly shortened on 14 d and 21 d (P<0.05) ; compared with CO group, the average escape latency of HBO group on 7 d, 14 d and 21 d was significantly shortened (P<0.05) . Compared with NC group, plasma HMGB1 in CO group and HBO group were significantly increased (P<0.05) ; after 3 days, HBO group was significantly lower than co group, the difference was statistically significant (P<0.05) . The levels of IL-6 and TNF-α in HBO group and co group increased rapidly and then decreased gradually. The increased levels of IL-6 and TNF-α in HBO group were significantly lower than those in CO group (P<0.05) . Compared with NC group, the expression of HMGB1 and Caspase-3 in CO group was significantly increased on 3 d, 7 d and 14 d (P<0.05) ; the expression of HMGB1 and Caspase-3 in HBO group was significantly increased on 3 d, 7 d, 14 d and 21 d (P<0.05) ; compared with CO group, the expression of HMGB1 and Caspase-3 in HBO group decreased significantly on 3 d, 7 d, 14 d and 21 d (P<0.05) . The apoptotic index of nerve cells in CO group began to increase at 3 days, which was significantly different from that of NC group (P<0.05) , and the difference was still statistically significant on 21 d (P<0.05) ; the apoptotic index of nerve cells in HBO group was slightly increased, but there was no significant difference compared with NC group (P>0.05) , and the apoptotic index of 3 d, 7 d, 14 d and 21 d in HBO group was significantly lower than that in CO group (P<0.05) . Conclusion: acute CO poisoning can induce the release of HMGB1 and a variety of inflammatory factors. HMGB1 can promote the apoptosis of nerve cells after acute CO poisoning by up regulating the expression of caspase-3 protein, and participate in the pathological process of DEACMP. HBO can down regulate the expression of HMGB1, IL-6, TNF-α and caspase-3 protein, inhibit the apoptosis of nerve cells, and play a protective role on nerve cells.

Recurrent arterial thrombosis of the lower extremity with secondary thrombocythemia due to reperfusion injury: a case report

Thrombocythemia is an important cause for thrombogenesis and can be classified as essential or secondary according to the etiology. Secondary thrombocythemia (ST), also called reactive thrombocytosis, is caused by a disorder that triggers increased production by normal platelet-forming cells and is characterized in terms of abnormal increased number of platelet in blood and megakaryocytes in bone marrow. Previous reports have found that complications from malignant tumors, chronic inflammation, acute inflammation, acute hemorrhage, spleen resection etc. to be the common causes of ST. A 53-year-old Chinese male with right lower limb arterial ischemic embolism developed recurring arterial thrombosis at the previous site after operation. During his hospitalization, the patient had a platelet count that was positively correlated with alanine transaminase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase (CK), and creatine kinase isoenzyme MB (CK-MB) while his thromboelastogram (TEG) and platelet aggregation test obtained by sequential platelet count showed inconsistent platelet function. We describe a case in which ischemia-reperfusion injury caused ST and recurrent thrombosis and analyse the probable cause of contradictory results of different platelet function tests. In thrombolytic therapy, we recommend adding platelet count and two more platelet aggregation tests to the routine laboratory items to aid in the prevention of recurrent thrombosis.

Novel SLC26A6 gene polymorphism rs184187143 is associated with diabetic ketoacidosis of gestational diabetes

OBJECTIVE

Diabetic ketoacidosis is one of the most serious acute complications of the gestational diabetes and is marked by the triad of the uncontrolled hyperglycemia, acidosis, and ketosis. Diabetic ketoacidosis can be a life-threatening emergency for mother and fetus, whose genetic factors resulting in diabetic ketoacidosis remain unclear. This study aimed to explore the correlation between SLC26A6 gene polymorphism rs184187143 and the risk of diabetic ketoacidosis of gestational diabetic mellitus (GDM).

PATIENTS AND METHODS

A total of 98 patients with GDM and 98 patients with diabetic ketoacidosis of GDM were enrolled. The direct sequencing of the products by Polymerase Chain Reactions of the extracted genomic DNA from the involved patients was performed to analyze the SLC26A6 gene polymorphism rs184187143, and the further genotype frequencies were compared to the statistical analysis of the clinical and biochemical data.

RESULTS

A significantly increased prevalence of the G allele (p = 0.032, OR = 2.326, 95% CI = 1.539-3.516), C/G genotype (p = 0.021, OR = 3.582, 95% CI = 1.216-10.558), and a previously uncharacterized rs184187143, was discovered in the diabetic ketoacidosis of the GDM group. The genotype of SLC26A6 rs184187143 was shown to be markedly associated with increased prevalence of the diabetic ketoacidosis of GDM.

CONCLUSIONS

Our study firstly established that the G allele and C/G genotype of rs184187143 single nucleotide polymorphism (SNP) in SLC26A6 gene was closely linked with the increased risk for the development of the diabetic ketoacidosis of GDM.

AB0243 THE SHORT DISEASE DURATION IS ASSOCIATED WITH WORSE MOOD DISORDER IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is commonly associated with mood disorders, especially depression and anxiety. But the status of mood disorders in RA patients with different courses is unknown.

Objectives:

The aims of this study were to investigate the frequencies of depression and anxiety in patients with early RA and non-early RA, and further to identify the risk factors for mood disorders.

Methods:

Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to all enrolled RA patients to assess their corresponding status of anxiety and depression. Besides clinical assessment, power Doppler and grey-scale ultrasound of 22 joints were also performed. The status of mood disorder was studied in early RA patients compared to non-early RA patients. Multivariate regression was used to identify the risk factor for mood disorders.

Results:

201 RA patients were enrolled, with 76 early RA (disease duration≤2 years) and 125 non-early RA (disease duration > 2 years) patients. Mood disorder (depression and/or anxiety) was found in 20.9% (42/201) patients. Depression was more often observed in early RA patients than non-early RA patients (26.3% vs. 14.4%,P=0.036). The similar trend for anxiety was observed also in early RA patients compared to non-early RA patients, although the difference was insignificant (13.2% vs. 5.6%,P=0.062). Multivariate logistic regression analysis showed that disease duration (OR 0.991 [95% CI 0.985-0.998]), rheumatoid factor concentration (OR 2.697 [95% CI 1.165-6.241]), Health Assessment Questionnaire Disability Index (HAQ-DI) (OR 1.045 [95% CI 1.001-1.091]) and grey-scale synovitis score (GS score) (OR 1.092 [95% CI 1.032-1.156]) were independent risk factors for predicting depression in RA. Disease duration (OR 0.983 [95% CI 0.970-0.997]), HAQ-DI (OR 1.069 [95% CI 1.002-1.141]) and GS score (OR 1.073 [95% CI 1.005-1.141]) were independent risk factors for predicting anxiety in RA patients.

Conclusion:

Mood disorders were almost doubled in frequency in early RA patients than non-early RA patients. RA Patients with short disease duration, high HAQ-DI and high GS score were more likely to be in depression and anxiety. More attention is needed to the psychological status of RA patients, especially those at an early stage, with poor physical function and severe synovitis.

References:

[1]Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol 2016;12(9):532-42.

[2]Bacconnier L, Rincheval N, Flipo RM, et al. Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort. Rheumatology (Oxford) 2015; 54(3): 520-7.

Acknowledgments:

The authors thank all the colleagues in our department.

Disclosure of Interests:

None declared

SAT0562 ADDITIONAL BENEFIT OF ULTRASOUND TO THE EARLY DIAGNOSIS OF PSORIATIC ARTHRITIS

Background:

Being an inflammatory disease of joint, spine or enthesis is the premise of the CASPAR diagnostic criteria for psoriatic arthritis (PsA). Traditionally, the assessment of local inflammation in joint, enthesis and tendon relies on physical examinations. But multiple studies have demonstrated that ultrasound (US) is capable of detecting subclinical inflammation as well as non-inflammatory lesions.

Objectives:

To compare the capabilities of physical examination and US findings in the diagnosis of early PsA, and further identify the US features which are most valuable for the diagnosis of PsA.

Methods:

66 patients with suspected PsA or early PsA (disease duration< 2 years) due to psoriasis with joint pain or seronegative inflammatory arthritis were enrolled and further assessed by both physical examination and ultrasound (US).Tender and swollen joint counts based on 68/66 joints, tender tendons, enthesitis (14 entheses) and dactylitis (20 digits) count were collected by physical examination. Abnormalities of peripheral joints, entheses and tendons were also evaluated by US. New bone formation was evaluated by hand X-ray. The diagnostic capacity of CASPAR criteria based on US and based on physical examination were compared. The diagnosis value of US features as well as clinical characteristics were analyzed. The clinical diagnosis of PsA by the expert panel was taken as the standard.

Results:

CASPAR criteria based on US showed a higher specificity than those based on physical examination (96.7% vs. 53.3%) with a bit decrease of sensitivity (91.7% vs. 97.2%). 36 patients were eventually diagnosed as PsA and 30 patients were non-PsA. Gender distribution, mean age and disease duration were equally distributed in two groups of patients. Dermatology Life Quality Index (DLQI) was higher in PsA patients than non-PsA patients. Significantly more patients had nail change and new bone formation on hand X-ray in PsA patients than in non-PsA patients (69.4% vs. 26.7%,P=0.001 and 66.7% vs. 13.3%,P<0.001 respectively). Significantly higher frequencies of synovitis/synovium hypertrophy, tenosynovitis and enthesitis were found in PsA patients than non-PsA patients (58.3% vs 20.0%,P=0.002, 38.9% vs 3.3%,P=0.001 and 52.8% vs 13.3%,P=0.002, respectively). Logistic regression analysis showed that nail change (OR=25.1, P=0.007), new bone formation on X-ray (OR=33.1, P=0.003), tenosynovitis on US (OR=149.1, P=0.003) and enthesitis on US (OR=39.2, P=0.008) were independent risk factors for predicting the diagnosis of PsA.

Conclusion:

US increased the specificity of CASPAR criteria compared with physical examination. Combined nail change, new bone formation on X-ray, tenosynovitis and enthesitis on US improved the diagnosis of early PsA.

References:

[1]Polachek A, Cook R, Chandran V, et al. The association between sonographic enthesitis and radiographic damage in psoriatic arthritis. Arthritis Res Ther 2017; 19(1): 189.

[2]Faustini F, Simon D, Oliveira I, et al. Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: a cross-sectional and longitudinal analysis. Ann Rheum Dis 2016; 75(12): 2068-74.

Acknowledgments:

The author thank all the colleagues in the department of Rheumatology of Guy’s hospital.

Disclosure of Interests:

None declared

Afatinib versus methotrexate as second-line treatment in Asian patients with recurrent or metastatic squamous cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 3): an open-label, randomised phase III trial

BACKGROUND

Treatment options are limited for patients with recurrent or metastatic squamous cell carcinoma of the head and neck (HNSCC) following progression after first-line platinum-based therapy, particularly in Asian countries.

PATIENTS AND METHODS

In this randomised, open-label, phase III trial, we enrolled Asian patients aged ≥18 years, with histologically or cytologically confirmed recurrent/metastatic HNSCC following first-line platinum-based therapy who were not amenable for salvage surgery or radiotherapy, and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0/1. Patients were randomised (2 : 1) to receive oral afatinib (40 mg/day) or intravenous methotrexate (40 mg/m2/week), stratified by ECOG performance status and prior EGFR-targeted antibody therapy. The primary end point was progression-free survival (PFS) assessed by an independent central review committee blinded to treatment allocation.

RESULTS

A total of 340 patients were randomised (228 afatinib; 112 methotrexate). After a median follow-up of 6.4 months, afatinib significantly decreased the risk of progression/death by 37% versus methotrexate (hazard ratio 0.63; 95% confidence interval 0.48-0.82; P = 0.0005; median 2.9 versus 2.6 months; landmark analysis at 12 and 24 weeks, 58% versus 41%, 21% versus 9%). Improved PFS was complemented by quality of life benefits. Objective response rate was 28% with afatinib and 13% with methotrexate. There was no significant difference in overall survival. The most common grade ≥3 drug-related adverse events were rash/acne (4% with afatinib versus 0% with methotrexate), diarrhoea (4% versus 0%), fatigue (1% versus 5%), anaemia (<1% versus 5%) and leukopenia (0% versus 5%).

CONCLUSIONS

Consistent with the phase III LUX-Head & Neck 1 trial, afatinib significantly improved PFS versus methotrexate, with a manageable safety profile. These results demonstrate the efficacy and feasibility of afatinib as a second-line treatment option for certain patients with recurrent or metastatic HNSCC.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01856478.

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

BACKGROUND

Primary tumour location is emerging as an important prognostic factor in localized and metastatic colorectal cancers. However, its prognostic role in colorectal liver metastasis (CRLM) after hepatectomy remains controversial. A systematic review and meta-analysis was undertaken to evaluate its prognostic value.

METHODS

References were identified through searches of PubMed, Embase, Web of Science and the Cochrane Library comparing overall or disease-free survival after hepatic resection between patients with CRLM originating from right- or left-sided colorectal cancers. Data were pooled using hazard ratios (HRs) and 95 per cent confidence intervals according to a random-effects model. Meta-regression and subgroup analyses were conducted to assess the effect of underlying confounding factors on HR estimates and to adjust for this.

RESULTS

The final analysis included 21 953 patients from 45 study cohorts. Compared with left-sided primary tumour location, right-sided location was associated with worse overall survival (HR 1·39, 95 per cent c.i. 1·28 to 1·51; P < 0·001; prediction interval 1·00 to 1·93), and also tended to have a negative impact on disease-free survival (HR 1·18, 1·06 to 1·32; P = 0·004; prediction interval 0·79 to 1·75). Subgroup analysis showed that the negative effect of right-sided primary tumour location on overall survival was more prominent in the non-Asian population (HR 1·47, 1·33 to 1·62) than the Asian population (HR 1·18, 1·05 to 1·32) (P for interaction <0·01).

CONCLUSION

This study demonstrated a prognostic role for primary tumour location in patients with CRLM receiving hepatectomy, especially regarding overall survival. Adding primary tumour location may provide important optimization of prognosis prediction models for CRLM in current use.

Rapid improvement of muscle weakness post-thymectomy indicates good long-term neurological outcome in patients with ocular myasthenia gravis

BACKGROUND AND PURPOSE

This study was conducted to evaluate whether post-thymectomy rapid remission of ocular myasthenia gravis (oMG) is a prognostic indicator of good long-term neurological outcome.

METHODS

Eighty-four oMG patients who underwent thymectomy at our institute were enrolled. The incidence of 5-year complete stable remission (CSR) was compared between patients with rapid remission of MG status (<1 month after surgery) and those with non-rapid remission.

RESULTS

Kaplan-Meier survival analysis indicated that the incidence of CSR was higher in oMG patients with rapid remission than in those without rapid remission (P < 0.001). Multivariate analysis showed that rapid remission (odds ratio 16.34, 95% confidence interval 3.58-74.60, P < 0.001) is an independent prognostic factor for CSR.

CONCLUSION

Postoperative rapid remission of MG status predicts a higher likelihood of complete remission in patients with oMG.

Evaluation and comparison of the diagnostic performance of routine blood tests in predicting liver fibrosis in chronic hepatitis B infection

Background & aims: Biopsy is the gold standard for staging liver fibrosis, but it may be accompanied by complications. As an alternative, non-invasive markers such as transient elastography (for liver fibrosis) and certain combinations of routine blood markers (liver function tests, full blood count) have been developed although their clinical significance remains controversial. Here, we compare the diagnostic values of non-invasive markers for liver fibrosis in patients with chronic hepatitis B infection. Methods: Transient elastography and routine laboratory tests were performed in 196 patients. Diagnostic performances were compared and were assessed based on the area under the curve (AUC) of a receiver operating characteristic (ROC) analysis. Results: Elevated GGT to platelet ratio (GPR), the fibrosis index FIB-4 [based on age, AST, platelets and ALT], platelet to lymphocyte ratio (PLR) and total bilirubin were independent predictors of liver stiffness defined by transient elastography (all P < 0.001). The AUCs of GPR in predicting both advanced fibrosis and cirrhosis were significantly larger than that of FIB-4 (P = 0.037 and P = 0.008, respectively) and AST-to-platelet ratio index (APRI) (P = 0.008 and P = 0.005). FIB-4, APRI and red cell volume distribution width-to-platelet ratio (RPR) had similar diagnostic values in discriminating different levels of liver fibrosis. Conclusions: GPR showed the best diagnostic value and RPR and PLR are easily available and inexpensive markers in evaluating fibrosis and cirrhosis. The diagnostic values of these laboratory markers are useful in diagnosing advanced fibrosis or cirrhosis, and in confirming the different levels of liver fibrosis.

Dexmedetomidine attenuation of renal ischaemia-reperfusion injury requires sirtuin 3 activation

BACKGROUND

Dexmedetomidine attenuates renal ischaemia and reperfusion (I/R) injury, but its mechanism of action is unclear. As sirtuin 3 (SIRT3) activation can alleviate acute kidney injury, we investigated whether dexmedetomidine acts through SIRT3 to reduce renal I/R injury.

METHODS

The potential involvement of SIRT3 in dexmedetomidine attenuation of renal I/R injury was tested in HK2 cells subjected to hypoxia/reoxygenation and C57BL/6J mice subjected to renal I/R. A short interfering RNA targeting SIRT3 was used in some experiments to examine the potential role of SIRT3. Cell death and mitochondrial membrane potential (Δψm) were analysed in cultured cells. Mitochondrial damage in mice was assessed using electron microscopy and markers for renal function. Expression of cyclophilin D, cytochrome c, and SIRT3, and the level of cyclophilin D acetylation were determined.

RESULTS

Hypoxia/reoxygenation of HK2 cells increased cell death, cytochrome C expression, and cyclophilin D acetylation, and decreased Δψm and SIRT3 expression (P<0.05). Dexmedetomidine attenuated these changes. The dexmedetomidine effects were enhanced by SIRT3 overexpression and eliminated by SIRT3 knockdown. I/R in mice damaged renal function, and increased histological lesions, mitochondrial damage, cytochrome c expression, and cyclophilin D acetylation, while SIRT3 activity was decreased by 51% (P<0.05). Dexmedetomidine inhibited these changes in mice expressing normal levels of SIRT3, but not in SIRT3-knockdown mice.

CONCLUSIONS

Dexmedetomidine appears to act, at least in part, by up-regulating SIRT3 to inhibit mitochondrial damage and cell apoptosis and thereby protect against renal I/R injury.

Wavelength multiplexing of four-wave mixing based fiber temperature sensor with oil-filled photonic crystal fiber

A fiber temperature sensor based on four-wave mixing (FWM) with an oil-filled photonic crystal fiber (PCF) is proposed in this study, and a multipoint measurement based on the wavelength multiplexing of such sensors is constructed for the first time. The sensing performance and signal spectral characteristics of the temperature sensor are theoretically and experimentally studied. The maximum temperature sensitivity of the signal light of 0.207 nm/°C is achieved using a FWM sensing fiber with a length of 10 cm. The signal wavelength response to excitation power is also explored in this experiment. Results showed that the temperature sensor is relatively insensitive to the fluctuation of power change. The wavelength multiplexing of a FWM-based PCF temperature sensor also presents the possibility of multiplexing measurement and multipoint sensing, and high multiplexed capability is theoretically predicted to be obtainable with optimized sensitivity and splicing loss.

Effects of chronic dexamethasone exposure on bile acid metabolism and cecal epithelia function in goats

Bile acids (BAs) are synthesized in the liver via the oxidation of cholesterol and further metabolized by microbiota in the gut, where they simultaneously impact gut function. In the present study, 10 goats were randomly divided into 2 groups; 1 group was injected with dexamethasone (Dex; 0.2 mg/kg), and the other group was injected with saline as the control (Con) for 21 d. Expression levels of key genes and proteins in the liver and gut mucosa were analyzed and compared to investigate the impact of chronic stress on BA metabolism and related functions in ruminants. The results revealed that Dex decreased plasma total BAs (TBAs) concentration (P < 0.05) but increased TBA concentration in the cecal digesta (P < 0.05). Total cholesterol in the liver decreased moderately in response to Dex. The protein expression of cytochrome P450 family 7 subfamily A member 1 and cytochrome P450 family 27 subfamily A member 1, 2 enzymes that control BA synthesis in the liver, remained unchanged by Dex administration (P > 0.05). The expression of several genes in the cecal mucosa encoding epithelial tight junction proteins, including occludin (P < 0.05), tight junction protein 1 (P < 0.01), and claudin 1 (P < 0.05), increased significantly in response to Dex, and expression of defensin beta 1, which can strengthen the innate immune system, was also upregulated (P < 0.05). In addition, BAs increased the expression of the Solute Carrier family 9 member A 2 (P < 0.01) that encodes a sodium hydrogen exchanger. These results suggest that the Dex-induced disruption of BA homeostasis might be mediated through a liver-independent pathway in goats, and the Dex-induced accumulation of TBAs in the cecal digesta may improve volatile fatty acid transportation and mucosal defense.

Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus

Objectives

To investigate the mortality and causes of death in Chinese patients with systemic lupus erythematosus.

Methods

We collected the clinical data of all consecutive adult systemic lupus erythematosus patients at the Rheumatology department of Peking University First Hospital between January 2007 and December 2015. The primary causes of death were identified, the standardized mortality ratio and years of life lost were calculated, and the survival and variables associated with mortality were determined by Kaplan–Meier and Cox regression analysis respectively.

Results

The mean age of all 911 patients (814 females and 97 males) was 37.8 ± 14.7 years, the median disease duration at recruitment was 2.6 (0.5–7.0) years, and the median follow-up duration was 3.0 (1.4–5.1) years. Among the 911 patients who were successfully followed up, 45 patients died. Infection (31.1%) was the leading cause of death followed by renal failure, pulmonary arterial hypertension and cerebrovascular diseases. The overall age and sex-adjusted standardized mortality ratio was 3.2 (95% confidence interval 2.4–4.0), and the years of life lost for women and men were 29.8 and 9.4 respectively. Overall survival at 1, 5 and 10 years was 98.2%, 95.3% and 93.7% respectively. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were independent risk factors for the mortality of systemic lupus erythematosus patients, and longer disease duration at recruitment was an independent protective factor.

Conclusions

Mortality of systemic lupus erythematosus patients in China was substantial, especially in females, with infection the leading cause of death. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were associated with poor outcomes.

All-optical multilevel amplitude regeneration in a single nonlinear optical loop mirror

We experimentally demonstrate all-optical amplitude regeneration of 4-level pulse amplitude modulated signals (PAM4) based on a single nonlinear optical loop mirror (NOLM). Four power-plateau regions are achieved using return-to-zero (RZ) pulses of narrow pulse-width, enabling large nonlinear phase shifts within the highly nonlinear fiber (HNLF). We quantify noise suppression characteristics at each amplitude level and obtain an overall EVM improvement of 0.92dB by optimizing input power and distortion strength. A theoretical analysis has been also carried out matching the experimental results and revealing the design characteristics of the regenerator's nonlinear transfer function.

Development of an Open Metadata Schema for Prospective Clinical Research (openPCR) in China

Objectives: In China, deployment of electronic data capture (EDC) and clinical data management system (CDMS) for clinical research (CR) is in its very early stage, and about 90% of clinical studies collected and submitted clinical data manually. This work aims to build an open metadata schema for Prospective Clinical Research (openPCR) in China based on openEHR archetypes, in order to help Chinese researchers easily create specific data entry templates for registration, study design and clinical data collection.

Methods: Singapore Framework for Dublin Core Application Profiles (DCAP) is used to develop openPCR and four steps such as defining the core functional requirements and deducing the core metadata items, developing archetype models, defining metadata terms and creating archetype records, and finally developing implementation syntax are followed.

Results: The core functional requirements are divided into three categories: requirements for research registration, requirements for trial design, and requirements for case report form (CRF). 74 metadata items are identified and their Chinese authority names are created. The minimum metadata set of openPCR includes 3 documents, 6 sections, 26 top level data groups, 32 lower data groups and 74 data elements. The top level container in openPCR is composed of public document, internal document and clinical document archetypes. A hierarchical structure of openPCR is established according to Data Structure of Electronic Health Record Architecture and Data Stand -ard of China (Chinese EHR Standard). Meta-data attributes are grouped into six parts: identification, definition, representation, relation, usage guides, and administration.

Discussions and Conclusion: OpenPCR is an open metadata schema based on research registration standards, standards of the Clinical Data Interchange Standards Consortium (CDISC) and Chinese healthcare related stand -ards, and is to be publicly available throughout China. It considers future integration of EHR and CR by adopting data structure and data terms in Chinese EHR Standard. Archetypes in openPCR are modularity models and can be separated, recombined, and reused. The authors recommend that the method to develop openPCR can be referenced by other countries when designing metadata schema of clinical research. In the next steps, openPCR should be used in a number of CR projects to test its applicability and to continuously improve its coverage. Besides, metadata schema for research protocol can be developed to structurize and standardize protocol, and syntactical interoperability of openPCR with other related standards can be considered.

Bone mass loss is associated with systolic blood pressure in postmenopausal women with type 2 diabetes in Tibet: a retrospective cross-sectional study

We conducted an observational cross-section study to investigate the status of bone mineral mass of Tibetan postmenopausal women with type 2 diabetes and the possible predictors for osteoporosis. We found that prevalence of osteoporosis was 27.0% and blood pressure was an independent risk factor for bone mass loss.

INTRODUCTION

The aims of this study is to investigate the prevalence of osteoporosis in postmenopausal women with type 2 diabetes dwelling in Tibet and the possible risk factors for bone mass loss.

METHODS

We recruited 99 Chinese Tibetan postmenopausal women with type 2 diabetes from the department of endocrinology of People's Hospital Tibet Autonomous Region. Multiple sites of bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DXA). The subjects were divided into three groups based on BMD T-score: osteoporosis, osteopenia, and normal. The clinical characteristics were compared between groups. The risk factors for bone mass loss were assessed by multiple linear regression analysis.

RESULTS

Among diabetic postmenopausal women dwelling in high altitude, mean age was 62 ± 8 years, the median postmenopausal period was 12 years (5, 20), the median duration of diabetes mellitus was 3 years (1, 8), and mean BMI was 27.6 ± 4.2 kg/m². Patients (52.5%) had hypertension. The percentages of patients with osteoporosis, osteopenia and normal BMD were 27.3, 42.4, and 30.3%, respectively. HbA1c and systolic blood pressure (SBP) were independently associated with T-scores of spine; ages and SBP were independently associated with T-scores of femoral neck or hip.

CONCLUSIONS

Among diabetic postmenopausal women dwelling in high altitude, 27.3% patients have osteoporosis, 42.4% patients have osteopenia, and 30.3% are normal. The BMD T-score of spine was inversely associated with SBP and positively associated with HbA1c, while the BMD T-score of femoral neck or hip was inversely associated with ages and SBP.

Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: early outcomes and technical details

Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor-Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, this study developed a modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing or knotting, nor special instruments such as an OrVil system or a reverse-puncture head are required. Between October 2015 and January 2016, 15 consecutive patients with cancer in the distal third of the esophagus or the gastric cardia underwent this modified surgical procedure. The good short-term outcomes that were achieved suggest that the modified anastomotic technique is safe and feasible for thoracolaparoscopic Ivor-Lewis esophagectomy.

Stimuli-responsive NLO properties of tetrathiafulvalene-fused donor–acceptor chromophores

Tetrathiafulvalene-fused electron donor–acceptor dyads display second order nonlinear optical properties that can be triggered by a pH or a redox stimulus.

Human umbilical cord mesenchymal stem cells ameliorate experimental cirrhosis through activation of keratinocyte growth factor by suppressing microRNA-199

OBJECTIVE

Keratinocyte growth factor (KGF) has a demonstrated role in the prevention of cirrhosis during liver regeneration. Previous studies have shown that transplantation of human umbilical cord mesenchymal stem cells (HUCMSCs) reduces the development of cirrhosis after liver injury. However, whether KGF may be involved in the underlying molecular mechanisms remains unknown. Here we addressed this question.

MATERIALS AND METHODS

We did HUCMSC transplantation in mice that had developed cirrhosis by carbon tetrachloride (CCl4). The effects of UCMSC transplantation on KGF levels and liver damage were examined. The level of a KGF-targeting microRNA, miR-199, was examined. The regulation of KGF by miR-199 was studied by bioinformatics analyses and luciferase reporter assay.

RESULTS

HUCMSC transplantation significantly ameliorated the severity of liver fibrosis, reduced portal hypertension and sodium retention that were induced by CCl4. HUCMSC transplantation significantly increased the levels of KGF in the injured liver, seemingly through suppression of miR-199, which targeted 3'-UTR of KGF mRNA to inhibit its protein translation.

CONCLUSIONS

HUCMSCs may ameliorate cirrhosis through activation of KGF by suppressing miR-199.

Insight into mechanics of AFM tip-based nanomachining: bending of cantilevers and machined grooves

Atomic force microscope (AFM) tip-based nanomachining is currently the object of intense research investigations. Values of the load applied to the tip at the free end of the AFM cantilever probe used for nanomachining are always large enough to induce plastic deformation on the specimen surface contrary to the small load values used for the conventional contact mode AFM imaging. This study describes an important phenomenon specific for AFM nanomachining in the forward direction: under certain processing conditions, the deformed shape of the cantilever probe may change from a convex to a concave orientation. The phenomenon can principally change the depth and width of grooves machined, e.g. the grooves machined on a single crystal copper specimen may increase by 50% on average following such a change in the deformed shape of the cantilever. It is argued that this phenomenon can take place even when the AFM-based tool is operated in the so-called force-controlled mode. The study involves the refined theoretical analysis of cantilever probe bending, the analysis of experimental signals monitored during the backward and forward AFM tip-based machining and the inspection of the topography of produced grooves.