[Efficacy analysis of 7 cases of mixed neuroendocrine-nonneuroendocrine neoplasm of the duodenal papilla]

The clinical data of 7 patients diagnosed with mixed neuroendocrine-nonneuroendocrine neoplasm were analyzed in the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital from January 2016 to December 2022. Among the 7 patients, 5 were male and 2 were female, with an average age of 59.3 years. Its clinical characteristics are similar to malignant ampulla tumors, and it is difficult to differentiate them. The preoperative puncture biopsy positivity rate is low, making it difficult to diagnose preoperatively, and the prognosis is worse.Comprehensive treatment including surgery, chemotherapy, and radiotherapy can be the preferred treatment option for this disease.

Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: are sink drains to blame?

BACKGROUND

Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU).

AIM

To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission.

METHODS

This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen.

FINDINGS

Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks.

CONCLUSION

Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.

The utility of behavioral biometrics in user authentication and demographic characteristic detection: a scoping review

BACKGROUND

Objective measures of screen time are necessary to better understand the complex relationship between screen time and health outcomes. However, current objective measures of screen time (e.g., passive sensing applications) are limited in identifying the user of the mobile device, a critical limitation in children's screen time research where devices are often shared across a family. Behavioral biometrics, a technology that uses embedded sensors on modern mobile devices to continuously authenticate users, could be used to address this limitation.

OBJECTIVE

The purpose of this scoping review was to summarize the current state of behavioral biometric authentication and synthesize these findings within the scope of applying behavioral biometric technology to screen time measurement.

METHODS

We systematically searched five databases (Web of Science Core Collection, Inspec in Engineering Village, Applied Science & Technology Source, IEEE Xplore, PubMed), with the last search in September of 2022. Eligible studies were on the authentication of the user or the detection of demographic characteristics (age, gender) using built-in sensors on mobile devices (e.g., smartphone, tablet). Studies were required to use the following methods for authentication: motion behavior, touch, keystroke dynamics, and/or behavior profiling. We extracted study characteristics (sample size, age, gender), data collection methods, data stream, model evaluation metrics, and performance of models, and additionally performed a study quality assessment. Summary characteristics were tabulated and compiled in Excel. We synthesized the extracted information using a narrative approach.

RESULTS

Of the 14,179 articles screened, 122 were included in this scoping review. Of the 122 included studies, the most highly used biometric methods were touch gestures (n = 76) and movement (n = 63), with 30 studies using keystroke dynamics and 6 studies using behavior profiling. Of the studies that reported age (47), most were performed exclusively in adult populations (n = 34). The overall study quality was low, with an average score of 5.5/14.

CONCLUSION

The field of behavioral biometrics is limited by the low overall quality of studies. Behavioral biometric technology has the potential to be used in a public health context to address the limitations of current measures of screen time; however, more rigorous research must be performed in child populations first.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been pre-registered in the Open Science Framework database ( https://doi.org/10.17605/OSF.IO/92YCT ).

A simple and convenient model combining multiparametric MRI and clinical features to predict tumour-infiltrating lymphocytes in breast cancer

AIM

To develop a simple and convenient method based on multiparametric magnetic resonance imaging (MRI) and clinical features to non-invasively predict tumour-infiltrating lymphocytes (TILs) in breast cancer (BC) and to explore the relationship between TIL levels and disease-free survival (DFS).

MATERIALS AND METHODS

A total of 172 BC patients were enrolled between November 2017 and June 2021 in this retrospective study. The patients were divided into high (≥10%) and low (<10%) TIL groups. Clinicopathological data were collected. MRI features were reviewed by two radiologists. Predictors associated with TILs were determined by using multivariable logistic regression analyses. Kaplan-Meier survival curves based on TIL levels were used to estimate DFS.

RESULTS

A total of 102 patients with low TILs and 70 patients with high TILs were included in the study. Tumour size (odds ratio [OR], 1.040; 95% confidence interval [CI]: 1.006, 1.075; p=0.020), apparent diffusion coefficient (ADC; OR, 1.003; 95% CI: 1.001, 1.005; p=0.015), clinical axillary lymph node status (CALNS; OR, 3.222; 95% CI: 1.372,7.568; p=0.007), and enhancement pattern (OR, 0.284; 95% CI: 0.143, 0.563; p<0.001) were independently associated with TIL levels. These features were used in the ALSE model (where A is ADC, L is CALNS, S is size, and E is enhancement pattern). High TILs were associated with better DFS (p=0.016).

CONCLUSION

The ALSE model derived from multiparametric MRI and clinical features could non-invasively predict TIL levels in BC, and high TILs were associated with longer DFS, especially in human epidermal growth factor receptor 2 (HER2)-positive BC and triple-negative BC (TNBC).

Plant size, latitude, and phylogeny explain within-population variability in herbivory

Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.

Altered serum metabolic profile in patients with IgA nephropathy

BACKGROUND

We investigated alterations in the serum metabolomic profile of IgA nephropathy (IgAN) patients and screen biomarkers of IgA nephropathy based on ultra-performance liquid chromatography-mass spectrometry (UPLC-MS).

METHODS

Serum samples from 65 IgAN patients and 31 healthy controls were analyzed by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Univariate and multivariate analysis were performed to screen the differential metabolites. Differential metabolites should meet both the following two criteria: adjusted P < 0.05 in the univariate analysis and VIP value > 1 in the multivariate model. Pathway analysis was performed to reveal the metabolic pathways that were significantly influenced in IgAN. Spearman correlation analysis was applied to explore the correlation between metabolites and between the metabolites and clinicopathological features of IgAN. A random forest model and Logistics regression analysis were conducted to evaluate the predictive ability of the metabolites.

RESULTS

The metabolic profile was significantly altered in IgAN patients compared with healthy controls. Thirty-nine metabolites were identified, including glycerophospholipids, sphingolipids, vitamin K1, vitamin K2, bile acids and amino acids. Sphingolipid metabolism, ubiquinone and other terpenoid-quinone biosynthesis, and glycerophospholipid metabolism were found to be significantly disturbed in the pathway analysis. Differential metabolites were found to be associated with the clinical and pathological features of IgAN patients. Lanosterol, vitamin K1, vitamin K2, and β-elemonic acid were found to have promising predictive ability for IgAN.

CONCLUSIONS

We confirmed the differences in the metabolic profiles of IgAN patients and healthy controls and identified the differential metabolites of IgAN, which may help with the further exploration of the pathogenesis and treatment of IgAN.

Investigating the mechanism of interactive regulation of B-cell lymphoma-2/Beclin 1 through electroacupuncture intervention during reperfusion in myocardial ischemia-reperfusion injury in a rat model

To observe the regulation of B-cell lymphoma-2 (Bcl-2)/Beclin 1 interaction through electroacupuncture (EA) intervention during reperfusion and to investigate the EA mechanism of apoptosis-autophagy interactive regulation against myocardial ischemia-reperfusion injury (MIRI). A total of 48 adult Sprague Dawley (SD) rats were randomly divided into the sham-operated group (group Sham), the model group (group Model), the EA group (group EA), and the JNK inhibitor (SP600125) group (group JNK), with 12 rats in each group. Biospecimens were collected randomly from six rats in each group four hours after reperfusion. Evans Blue and triphenyl tetrazolium chloride double-staining were applied to observe each group's myocardial damage area and risk area. We collected 4 ml of blood by abdominal aortic method to detect serum troponin cTnI level by enzyme-linked immunosorbent assay (ELISA). For the remaining six in each group, a part of myocardial tissue below the ligation line was stored in 4% paraformaldehyde for immunohistochemistry and TUNEL staining; the other amount of myocardial tissue was detected by Western blotting to determine the expression levels of Bcl-2, Beclin1, and the phosphorylation levels of Thr69, Ser70, and Ser87 in Bcl-2. In results: electroacupuncture (EA) intervention during reperfusion significantly reduced the myocardial infarction area, cTnI level, and myocardial apoptosis, upregulated Bcl-2 expression, downregulated Beclin 1 expression and inhibited phosphorylation levels of Thr69, Ser70, and Ser87 in Bcl-2. We concluded that EA effectively inhibited apoptosis by upregulating Bcl-2 expression and inhibiting the phosphorylation of Thr69, Ser70, and Ser87 in Bcl-2. This reduced the separation of Bcl-2 and Beclin 1, restrains excessive autophagy, alleviates MIRI, and has a protective effect on myocardial tissue.

Probiotics ameliorate IgA nephropathy by improving gut dysbiosis and blunting NLRP3 signaling

Background

Recently, a few studies have indicated a relationship between the gut microbiota and IgA nephropathy (IgAN). Whether the gut microbiota participates in the pathogenesis of IgAN and whether probiotics are effective in treating IgAN are still controversial. Therefore, this study aimed to identify the differences in the structure of the gut microbiota between IgAN and controls and to evaluate the efficacy and mechanism of probiotics in the treatment of IgAN.

Methods

To address this question, 35 IgAN patients and 25 healthy volunteers were enrolled, and a mouse IgAN model was also constructed. The stool microbes were analyzed by 16S rRNA high-throughput sequencing to identify the differential strains between IgAN and healthy controls. The impact of probiotics on the structure of the intestinal flora and the efficacy of the probiotics in the treatment of IgAN were evaluated.

Results

Although the microflora structure of mice and humans was not the same, both patients and mice with IgAN exhibited gut microbiota dysbiosis, with all subjects presenting an evident decrease in Bifidobacterium levels. The Bifidobacterium proportion was negatively correlated with proteinuria and hematuria levels, indicating that the decreased Bifidobacterium abundance could be related to IgAN severity. Probiotic treatment containing Bifidobacterium in IgAN mice could significantly alleviate gut dysbiosis, specifically by increasing the proportion of beneficial bacteria and reducing the abundance of potentially pathogenic bacteria. Moreover, both probiotics and their metabolites, short-chain fatty acids (SCFAs), could attenuate IgAN clinicopathological manifestations by inhibiting the NLRP3/ASC/Caspase 1 signaling pathway.

Conclusions

Supplementation with probiotics mainly containing Bifidobacterium could markedly improve gut dysbiosis in IgAN. Moreover, both probiotics and their SCFA metabolites could attenuate the clinicopathological manifestations of IgAN by inhibiting the NLRP3/ASC/Caspase 1 signaling pathway. Therefore, probiotics have potential as an adjunctive therapy for IgAN.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-022-03585-3.

Case Report: Adolescent-Onset Isolated Nephronophthisis Caused by a Novel Homozygous Inversin Mutation

Objective: Nephronophthisis (NPHP) is a rare autosomal recessive inherited kidney disease that can cause cystic enlargement of the kidneys, and lead to end-stage renal disease (ESRD) before the age of 30 years. Herein we describe a case of adolescent-onset NPHP with a novel homozygous mutation in the inversin gene (INVS).

Methods: The patient was a 15-year-old Chinese boy who presented with ESRD. Genetic testing was performed via whole exome sequencing and validated via Sanger sequencing. A novel homozygous INVS mutation was identified (c. 1909C > T; p. Gln637Ter).

Results: The results of laboratory examinations included urinary protein 1.05 g/24 h, urine erythrocyte count 5/high-power field, serum creatinine 1,026.2 μmol/L, and estimated glomerular filtration rate 5.8 ml/min/1.73 mm². Extrarenal features included hypertension and moderate anemia, and his parents were consanguineous (first cousins). A homozygous 1-bp substitution resulting in a nonsense mutation (c. 1909C > T; p. Gln637Ter) in exon 15 of INVS was detected via whole exome sequencing, and validated via Sanger sequencing. According to the classification system of the American College of Medical Genetics and Genomics, the mutated gene in INVS is strongly pathogenic (PVS1+PM2+PP3+PP5). His parents and a younger brother were heterozygous carriers. Based on the above results he was diagnosed with juvenile type 2 NPHP. He underwent hemodialysis, and received a kidney transplant after 2 months. He is currently recovering well, with a serum creatinine level of 117 μmol/L and an estimated glomerular filtration rate of 79.6 ml/min/1.73 mm².

Conclusion: Here we have described an extremely rare case of adolescent-onset type 2 NPHP caused by a homozygous INVS mutation. The patient had progressed to ESRD by the age of 15 years. The current report will deepen our understanding of the clinical and genetic basis of this disease.

Intestinal dysbiosis featuring abundance of Streptococcus associates with Henoch-Schönlein purpura nephritis (IgA vasculitis with nephritis) in adult

Background

The pathogenesis of Henoch-Schönlein purpura nephritis (HSPN) is closely associated with mucosal infection. But whether intestinal microbiota dysbiosis plays a role in it is not clear.

Methods

A total of 52 participants including 26 HSPN patients and 26 healthy controls were included. By using 16S ribosomal RNA gene sequencing, the intestinal microbiota composition between HSPN and healthy controls was compared. The diagnostic potency was evaluated by Receiver operating characteristic (ROC) with area under curves (AUC). Meanwhile, correlation analysis was also performed.

Results

The lower community richness and diversity of fecal microbiota was displayed in HSPN patients and the structure of gut microbiota was remarkedly different. A genus-level comparison indicated a significant increase in the proportions of g-Bacteroides, g-Escherichia–Shigella and g-Streptococcus, and a marked reduction of g-Prevotella_9 in HSPN patients, suggesting that the overrepresentation of potential pathogens and reduction of profitable strains were the main feature of the dysbiosis. The differential taxonomic abundance might make sense for distinguishing HSPN from healthy controls, with AUC of 0.86. The relative abundance of the differential bacteria was also concerned with clinical indices. Among them, Streptococcus spp. was positively associated with the severity of HSPN (P < 0.050). It was found that HSPN patients with higher level of Streptococcus spp. were more likely to suffering from hematuria and hypoalbuminemia (P < 0.050).

Conclusions

The dysbiosis of gut microbiota was obvious in HSPN patients, and the intestinal mucosal streptococcal infection was distinctive, which was closely related to its severity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02638-x.

Arterial-Arteriolar Sclerosis Is Independently Associated With Poor Renal Outcome in IgA Nephropathy Patients

Aim: This study aimed to investigate the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) with arterial-arteriolar sclerosis (AS).

Methods: Patients with biopsy-proven IgAN from the West China Hospital of Sichuan University were retrospectively enrolled. Clinicopathological features were collected. Patients were categorized based on the presence and the severity of the AS. All the patients were regularly followed-up until a composite end point. The correlation between AS and prognosis of IgAN was assessed.

Results: A total of 1,424 patients were recruited and followed for 60.0 ± 28.7 months. Patients with AS tended to have older age, higher blood pressure, heavier proteinuria, higher serum creatinine, uric acid, and total triglyceride (TG). Meanwhile, they were more likely to have a lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin. At the end of follow-up, 126 patients in the AS group and 47 patients in the non-AS group had reached the composite end point (p < 0.001). AS was associated with the renal outcome (log-rank p < 0.001) and was an independent risk factor for the progression of IgAN (p = 0.049). The severity of AS was associated with renal outcomes (log-rank p < 0.001) and there was a trend that it might serve as an independent risk marker for progression of IgAN. In the subgroup analysis, patients presenting with AS and lower eGFR, albumin, and hemoglobin or higher proteinuria, uric acid, and TG had a significant trend for a shorter time to reach the end point (log-rank p < 0.001).

Conclusion: AS was commonly seen in patients with IgAN and was independently associated with the poor prognosis.

Characterization of serum adiponectin and leptin in healthy perinatal dairy cows or cows with ketosis, and their effectson ketosis involved indices

We investigated changes in concentrations of ADP (adiponectin), LEP (leptin), BHBA (beta-hydroxybutyric acid), NEFA (non-esterified fatty acid), Glucose (Glu) and INS (insulin) in serum of healthy perinatal dairy cows and cows with ketosis. Twenty-one healthy cows and seventeen cows with ketosis from a herd of a total 60 Holstein cows (near dry period i.e. 56 days antepartum) were selected. Blood was collected through the tail vein every 7 days, from 56 day antepartum to 56 day postpartum. Serum ADP, LEP, BHBA, NEFA, Glu, and INS concentrations were determined, and ketosis was diagnosed through serum BHBA (≥1.2 mmol/L). We showed the concentration of serum adipokines and energy balancing indices were stable during antepar- tum period. However, ADP concentration increased while LEP decreased, and there were a significant increase in cows with ketosis compared to that of in healthy cows. Serum BHBA and NEFA concentrations increased significantly at first, and then gradually decreased in both healthy cows and cows with ketosis. However, cows with ketosis showed higher concentrations of BHBA and NEFA which restored later. The serum concentration of Glu in both healthy dairy cows and cows with ketosis showed a decreasing trend. INS concentration in healthy cows was decreased while it was increased in cows with ketosis. The results reflect the extent of hypo- glycemia and lipid mobilization postpartum, suggest IR exists in cows with ketosis while serum ADP and LEP might play roles in the development of ketosis.

Mutations of the c-Kit and PDGFRA gene in gastrointestinal stromal tumors among hakka population of Southern China

Aims

The aim of the present study was to investigate mutation status of the cKit and PDGFRA genes in patients with a gastrointestinal stromal tumor (GIST).

Methods

In total, 96 patients with a GIST were included in the study, in which polymerase chain reaction amplification and gene sequencing were used to detect the sequences of exons 9, 11, 12, 13, 14, 17, and 18 in KIT and exons 12, 14, and 18 in PDGFRA.

Results

KIT mutations were detected in 65 cases (67.71%), of which 81.54% (53/65) were located on exon 11, 12.31% (8/65) were located on exon 9, 4.61% (3/65) were located on exon 17, which included a concomitant mutation of exon 9 and 11, and 4.08% (2/65) were located on exon 13, which included a concomitant mutation on exon 11. The most common mutation in exon 11 was deletion, which accounted for 77.36% (41/53) of the cases, followed by a point mutation observed in 22.64% (12/53) of the cases. Among the 31 GIST cases without a KIT mutation, a mutation in PDGFRA was detected in 5 cases (5.21%, 5/96; 16.13%, 5/31). With respect to gender, age, tumor max diameter, tumor position, and mitotic index, there were no significant differences between KIT/PDGFRA mutations and non-mutations.

Conclusions

GIST mainly occurs in the stomach, and the cytological morphology is mainly spindle cells, and the mutations mainly occur in KIT genes. We need a large sample size to analyze the regularity of GIST gene mutations in Hakka population and understand the independent prognostic correlation of all KIT/PDGFRA genotypes.

Serum Bilirubin Is Correlated With the Progression of IgA Vasculitis With Nephritis

Background: Bilirubin has been identified as an endogenous antioxidant and cellular protectant. The present study was performed to clarify the potential influence of serum bilirubin on IgA vasculitis with nephritis (IgAV-N). Methods: One hundred and eighty-nine IgAV-N patients over 14 years old were enrolled. The patients were divided into two groups by the optimum cut-off value calculated by ROC curve. The composite endpoints were defined as a 60% decline in estimate glomerular filtration rate (e-GFR), end-stage renal disease (ESRD) and/or death. Kaplan-Meier (K-M) analysis and multivariate Cox analysis were carried out to determine the predictors for renal outcomes. In order to eliminate the influence of different baseline data, a 1:2 propensity score (PS) match was performed to make the results comparable and convictive. Results: The baseline data suggested that patients in low serum bilirubin group had significantly higher levels of systolic blood pressure, proteinuria, serum creatinine and crescent formation ratio and lower levels of serum albumin and hemoglobin. Renal survival analysis indicated that lower serum bilirubin levels were significantly correlated with a poorer prognosis. Multivariate Cox analysis demonstrated that the higher level of serum bilirubin was an independent protective factor for renal survival (HR, 0.172; 95% CI, 0.030-0.991; P = 0.049). After PS matching, the baseline characters of two groups had no statistical differences. Similar outcomes were demonstrated in K-M curve and the multivariate Cox analysis. Conclusion: Elevated bilirubin levels might be related to the favorable renal outcomes.

AB0791 THE DIAGNOSIS VALUE OF SYNOVIAL FLUID LYMPHOCYTE IN GOUT PATIENTS

Background:

Synovial fluid cell counts have long been recognised to have utility in the diagnosis and management of arthritis. Few studies have explained the diagnosis value of synovial fluid cell counts in gout patients.

Objectives:

The study aims to investigate the diagnosis value of synovial fluid cell counts in gout patients.

Methods:

A total of 185 gout, 64 rheumatoid arthritis(RA), 26 axial spondyloarthritis(axSpA) and 24 osteoarthritis(OA) patients were included into the study. According to serum uric acid(sUA) level on attack, gout patients were divided into normal sUA gout patients and high sUA gout patients. The laboratory data was recorded and ROC curve was performed.

Results:

The synovial fluid WBC, PBMC, monocyte, PMN and neutrophil in gout patients were higher than OA patients (P<0.05). The synovial fluid PBMC and lymphocyte in gout patients were lower than RA and axSpA patients (P<0.05). Compared with RA, axSpA and OA patients, ROC curve showed that the AUC value of lymphocyte and sUA for gout were 0.728 and 0.881, which were higher than other variables. The optimal cut off value of lymphocyte for gout was 1.362, with sensitivity of 83.3% and specificity of 60.6%. The AUC value of lymphocyte and sUA for normal sUA gout patients were 0.694 and 0.643, which were higher than other variables. The optimal cut off value of lymphocyte for normal sUA gout patients was 1.362, with sensitivity of 81.6% and specificity of 60.6%.

Conclusion:

Synovial fluid cell counts of gout patients were different from RA, axSpA, and OA patients. Synovial fluid lymphocyte had a higher diagnosis value for gout.

References:

[1]Scanu A, Oliviero F, Ramonda R, et al. Cytokine levels in human synovial fluid during the different stages of acute gout: role of transforming growth factor β1 in the resolution phase. Ann Rheum Dis. 2012, 71(4): 621-4.

Table 1.

Basic characteristics of the participants

Gout(n=185)RA(n=64)axSpA (n=26)OA(n=24)P valueAge (years)48.58±15.5856.19±12.39*32.96±15.19*#69.63±12.43*#&<0.001Gender (male/female)176/911/5321/58/16<0.001WBC(×109/L)18.58±22.9422.24±20.8715.52±15.033.03±5.59*#&0.002PBMC(×109/L)1.85±1.993.68±2.43*3.85±3.34*0.74±1.01*#&<0.001Monocyte(×109/L)1.02±1.591.24±1.111.34±1.520.29±0.37*#&0.030PMN(×109/L)16.77±21.5118.57±19.3215.75±24.172.30±5.00*#&0.008Lymphocyte (×109/L)0.80±0.832.43±1.76*2.50±2.04*0.45±0.80#&<0.001Eosinophil (×109/L)1.32±3.750.56±0.930.11±0.170.49±1.850.098Neutrophil (×109/L)16.42±21.1618.82±20.8911.13±14.232.23±4.87*#0.003UA(μM)497.92±132.24299.31±97.91*351.81±118.93*333.38±75.19*<0.001ESR(mm/h)61.02±37.6882.42±32.87*68.12±36.2542.34±35.91*#&<0.001CRP(mg/L)56.52±45.6444.01±35.27*65.49±39.85#22.11±40.65*#&<0.001

*P<0.05 vs gout group, #P<0.05 vs RA group, &P<0.05 vs axSpA group

Disclosure of Interests:

None declared

POS1144 SERUM URIC ACID TO CREATININE RATIO IS ASSOCIATED WITH URINARY URIC ACID EXCRETION IN PATIENTS WITH GOUT

Background:

Underexcretion of uric acid is the dominant mechanism leading to hyperuricemia [1] and the 24-hour urinary uric acid excretion is an important measurement. However, it is inconvenient due to accurate timing and complete collection of the specimen.

Objectives:

The aim of this study was to investigate the relationship between serum uric acid to creatinine ratio (sUACR) and 24-hour urinary uric acid excretion in gout patients.

Methods:

A total of 110 gout patients fulfilling 2015 ACR/EULAR classification criteria from Guangdong Second Provincial General Hospital from January 2019 to January 2021 were retrospectively enrolled in this study. Patients were divided into underexcretion group (<3600 μmol/24h) and non-underexcretion group (≥3600 μmol/24h). The correlation between sUACR and 24-hour urinary uric acid excretion was analyzed by the Pearson’s correlations analysis. Receiver operation characteristic (ROC) curves were performed to assess the utility of sUACR for discriminating between underexcretion group and non-underexcretion group. Furthermore, the risk factors of uric acid underexcretion were evaluated using binary logistic regression analysis.

Results:

sUACR in the underexcretion group was significantly lower than the non-underexcretion group (p=0.0001). Besides, sUACR was positively correlated with 24-hour urinary uric acid excretion (r=0.4833, p<0.0001). Furthermore, ROC suggested that the area under the curve (AUC) of sUACR was 0.728, which was higher that of serum uric acid and creatinine. The optimal cutoff point of sUACR was 5.2312, with a sensitivity and specificity of 71.9% and 67.9%. Logistic analysis results revealed that decreased sUACR (<5.2312) was an independent risk factor of underexcretion of uric acid (OR =5.510, 95% CI: 1.952-15.550, P=0.001).

Conclusion:

sUACR is lower in gout patients with underexcretion of uric acid and may serve as a useful and convenient marker of assessing underexcretion of uric acid in gout patients.

References:

[1]Perez-Ruiz F, Calabozo M, Erauskin GG, Ruibal A, Herrero-Beites AM. Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum 2002; 47: 610–13.

Figure 1.

A. Comparison of serum uric acid to creatinine ratio between underexcretion group and non-underexcretion group. B. Correlation between serum uric acid to creatinine ratio and 24h uric acid excretion.

Disclosure of Interests:

None declared.

AB0645 CLINCAL CHARACTERISTICS OF GOUT PATIENTS WITH RENAL CYSTS

Background:

Gout is a crystal-related arthropathy caused by monosodium urate deposition, which is a common and treatable form of inflammatory arthritis and becoming more prevalent[1]. A few studies have found that gout patients have an increased prevalence of simple renal cysts[2, 3]. The relationship between gout and renal cysts is still insufficient.

Objectives:

Compare the difference between gout with renal cyst and without renal cyst.

Methods:

We retrospectively collected data on 200 gout patients. The data includes age, gender, uric acid, creatinine, glomerular filtration rate, 24-hour urine collection, and whether they have kidney stones, renal cysts, coronary heart disease, hypertension, and diabetes. Chi-square and exact Fisher’s tests were utilized, while continuous variables were assessed by Student’s t-test. A P value of less than 0.05 was considered statistically significant.

Results:

Of the 200 gout patients, 56 have kidney cysts(28%). In gout patients who had a renal cyst, were significantly older than patients without renal cysts (59.14 vs. 46.87, P = 0.000), more number of people suffering from coronary heart disease (7 vs. 5, P = 0.016). The glomerular filtration rate was lower (58.5 vs. 71.6, P = 0.000), with lower urinary creatinine, uric acid, and urinary potassium.

Conclusion:

Gout patients with and without simple renal cysts have significant differences in age, hypertension, cardiovascular disease, GFR, serum creatinine, urine creatinine, and urine potassium.

References:

[1]N. Dalbeth, T.R. Merriman, L.K. Stamp, Gout, Lancet 388(10055) (2016) 2039-2052.

[2]E.M. Hasegawa, R. Fuller, M.C. Chammas, F.M. de Mello, C. Goldenstein-Schainberg, Increased prevalence of simple renal cysts in patients with gout, Rheumatol Int 33(2) (2013) 413-6.

[3]Y. Han, M. Zhang, J. Lu, L. Zhang, J. Han, F. Zhao, H. Chen, Y. Bao, W. Jia, Hyperuricemia and overexcretion of uric acid increase the risk of simple renal cysts in type 2 diabetes, Sci Rep 7(1) (2017) 3802.

Table 1.

Clinical characteristics of gout patients

Renal cyst(n=56)Without Renal cyst(n=144)PDisease duration, (month)98.7(±64.1)91.2(±67.0)0.468Age, (year)59.14(±14.3)46.78(±15.9)0.000Gender, n(F/M)7/4911/1330.281Smoking history, n(%)18(32.1%)47(32.6%)0.946Drinking history, n(%)10(17.9%)32(22.2%)0.496Hypertension, n(%)31(55.3%)49(34.0%)0.006Diabetes, n(%)9(16.1%)15(10.4%)0.269CVDs, n(%)7(12.5%)5(3.4%)0.016Nephrolithiasis, n(%)14(25%)43(29.9%)0.494UA, (μmol/L)494.8(±158.0)544.3(±121.0)0.037Serum creatinine, (μmol/L)139.4(±57.2)116.5(±35.45)0.007GFR, (ml/L)58.5(±22.5)71.6(±22.3)0.000FEUA, (%)7.0(±3.2)6.0(±3.2)0.052Urine creatinine, (μmol/L)4687.09(±1832.9)5565.2(±2599.8)0.008Urine Uric acid, (μmol/L)1204.9(±772.0)1542.1(±1048.5)0.030Urine sodium, (mmol)132.1(±68.7)131.2(±76.6)0.939Urine potassium, (mmol)25.6(±12.5)31.8(±14.2)0.005

Disclosure of Interests:

None declared.

A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy

It was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan-Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074 .

The Influences of COVID-19 on Patients With Chronic Kidney Disease: A Multicenter Cross-Sectional Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) has attracted global attention. During the lockdown period of COVID-19, follow-up of many patients with chronic disease had been interrupted, which brought severe challenges to better management of their disease. This study aimed at exploring the change of illness, daily life, and psychological responses during the COVID-19 pandemic among chronic kidney disease (CKD) patients. Methods: A total of 612 patients were enrolled in this study; 282 patients were categorized into the CKD stage 1-2 group and 330 patients were categorized into the CKD stage 3-5 group. Among two groups, 168 (27.5%) and 177 (28.9%) patients were female with a median age of 42 and 45, respectively. The study was conducted by collecting the questionnaires in five nephrology centers. The questionnaire consisted of assessment of anxiety by using the Self-Rating Anxiety Scale and the influences of COVID-19, which included basic demographic data, the influences of COVID-19 on illness and daily life, as well as the patients' psychological responses during the epidemic. Results: A total of 612 patients were included and divided into two groups according to eGFR. Ninety-six patients (34%) in the CKD stage 1-2 group and 141 patients (42.7%) in the CKD stage 3-5 group had reduced their follow-up frequency (p = 0.031). More patients with CKD stages 1-2 consulted online (25.9%), p = 0.005. Besides, patients in the CKD stage 3-5 group tended to be more anxious about follow-up (p = 0.002), fearful of being infected with COVID-19 (p = 0.009), and more likely to feel symptoms getting worse (p = 0.006). The standard scores of SAS were 48.58 ± 7.082 and 51.19 ± 5.944 in the CKD stage 1-2 group and the CKD stage 3-5 group, respectively (p < 0.001). There were significant differences in the severity of anxiety (p = 0.004). Conclusion: COVID-19 had a greater impact on patients with CKD stages 3-5 than those with stages 1-2 in terms of illness, daily life, and psychological disorder. Patients with CKD stages 3-5 were more anxious during the COVID-19 pandemic.

A new generation of direct X-ray detectors for medical and synchrotron imaging applications

Large-area X-ray imaging is one of the most widely used imaging modalities that spans several scientific and technological fields. Currently, the direct X-ray conversion materials that are being commercially used for large-area (> 8 cm × 4 cm without tiling) flat panel applications, such as amorphous selenium (a-Se), have usable sensitivities of up to only 30 keV. Although there have been many promising candidates (such as polycrystalline HgI2 and CdTe), none of the semiconductors were able to assuage the requirement for high energy (> 40 keV) large-area X-ray imaging applications due to inadequate cost, manufacturability, and long-term performance metrics. In this study, we successfully demonstrate the potential of the hybrid Methylammonium lead iodide (MAPbI3) perovskite-based semiconductor detectors in satisfying all the requirements for its successful commercialization in synchrotron and medical imaging. This new generation of hybrid detectors demonstrates low dark current under electric fields needed for high sensitivity X-ray imaging applications. The detectors have a linear response to X-ray energy and applied bias, no polarization effects at a moderate bias, and signal stability over long usage durations. Also, these detectors have demonstrated a stable detection response under BNL's National Synchrotron Light Source II (NSLS-II) 70 keV monochromatic synchrotron beamline.

Global Glomerulosclerosis and Segmental Glomerulosclerosis Could Serve as Effective Markers for Prognosis and Treatment of IgA Vasculitis With Nephritis

Background: This study was aimed at investigating the clinical significance and curative effect of global glomerulosclerosis (GS) and segmental glomerulosclerosis (S) in adult-onset IgA vasculitis with nephritis (IgAV-N) patients since there was no consensus pathological grading method for adult IgAV-N. Methods: A total of 188 biopsy-proven IgAV-N patients were prospectively identified. Patients were separately assigned to GS0/GS1/GS2 group and S0/S1/S2 based on the scores of global glomerulosclerosis and segmental glomerulosclerosis (0% /0-15% />15%, respectively). Results: GS0, GS1, and GS2 occurred in 56.4, 29.2, and 14.4% of the adult-onset IgAV-N, respectively. Patients in GS2 group tended to have the most serious renal deterioration and the highest levels of blood pressure. IgAV-N patients were also divided into S0 group (64.4%), S1 group (20.7%), and S2 group (14.9%), where no obvious differences in baseline data were noted. K-M curves indicated that GS2 group had the worst renal outcome (P = 0.05) while there seemed to be no significant differences between GS0 group and GS1 group. In addition, no remarkable differences in primary outcome were found among S0 group, S1 group, and S2 group though the prognosis of S2 group tended to be the worst. However, the prognosis of S0/S1 group was markedly better than that of S2 (P = 0.04). The discrimination of poor prognosis could be improved by adding the pathological indicators of global glomerulosclerosis and segmental glomerulosclerosis. Most importantly, immunosuppressive treatment might be a superior alternative in IgAV-N patients without sclerosis scores or with lower level of sclerosis scores. But addition of immunosuppression was not recommended in patients with higher sclerosis scores. Conclusions: Global glomerulosclerosis and segmental sclerosis might be used for management and treatment of adult-onset IgAV-N.

2D shear wave elastography combined with age and serum biomarkers prior to kasai surgery predicts native liver survival of biliary atresia infants

BACKGROUND

The prognosis of patients with biliary atresia (BA) after Kasai portoenterostomy (KPE) varies, and precisely predicting the outcomes of KPE before surgery is still challenging.

METHODS

A total of 158 patients who underwent KPE in our hospital were included in this study. The patients in the training cohort were recruited from January 2012 to October 2017 (n = 118), and then, those in the validation cohort were recruited from November 2017 to April 2019 (n = 40). Combined nomogram models were developed based on two-dimensional shear wave elastography (2D SWE) values and other biomarkers. The utility of the proposed models was evaluated by C-index.

RESULTS

2D SWE played a potentially important role in predicting native liver survival (NLS) of BA patients with a C-index of 0.69 (0.63 to 0.75) in the training cohort and 0.76 (0.67 to 0.85) in the validation cohort. The nomogram A based on 2D SWE values, age, gamma-glutamyl transferase (GGT) and aspartate aminotransferase-to-platelet ratio (APRI) had a better C-index in the training cohort [0.74 (0.68-0.80) vs. 0.66 (0.60-0.73), P = 0.017] and in the validation cohort [0.78 (0.70-0.86) vs. 0.60 (0.49-0.71), P = 0.002] than the nomogram B (without 2D SWE). Using risk score developed from nomogram A, we successfully predicted 88.0% (22/25) of patients in the training cohort and 75.0% (9/12) in the validation cohort to have survival time of less than 12 months after KPE.

CONCLUSION

The combined nomogram model based on 2D SWE values, age, GGT and APRI prior to KPE can effectively predict NLS in BA infants.

Corticosteroids Improve Renal Survival: A Retrospective Analysis From Chinese Patients With Early-Stage IgA Nephropathy

Background: The efficacy and safety of corticosteroids and immunosuppressive therapy remain controversial for the treatment of immunoglobulin A nephropathy (IgAN). This study aimed to evaluate the effects of corticosteroid and immunosuppressant therapy in Chinese patients with early-stage IgAN whose estimated glomerular filtration rate (eGFR) was ≥45 ml/min/1.73 m² and proteinuria was ≥1 g/24 h at biopsy.

Methods: Patients with biopsy-proven IgAN were retrospectively enrolled from four study centers between 2007 and 2016. Patients were regularly followed up for at least 1 year or until the study end point. Patients were categorized into three treatment groups: supportive care (SC), steroids alone (CS), and steroids plus immunosuppressants (IT). The observed responses to therapy included complete remission (CR), partial remission (PR), no response (NR), and end-stage renal disease (ESRD). The primary end point of the current study was defined as a 50% decline in eGFR and/or ESRD.

Results: A total of 715 patients (male 47% and female 53%) were recruited and followed up for 44.69 ± 24.13 months. The observed CR rate was 81.8% with corticosteroids alone (CS), 62.7% with corticosteroids + immunosuppresants (IT), and 37% with supportive care alone (SC). Renal outcomes were remarkably better in the CS group compared with the SC and IT groups (the percentage of patients reaching the end point in each group was 4.6 vs. 14.4 vs. 11.5%, respectively; p = 0.001). Moreover, 36 and 80-month renal survival were significantly better for the CS group (98.3 and 86.4%) than for the IT (94.2 and 82.4%) and SC (94.0 and 51.6%) groups. Early CKD stage also presented with better kidney survival (p < 0.001). Renal survival of CKD stage 1 patients was relatively good regardless of the specific treatment regimen. CS and IT treatment significantly improved renal survival for CKD stage 2 patients when compared with the SC group (p < 0.001 and 0.007, respectively). However, renal survival of CKD stage 3a patients was not impacted by any of the three treatment regimens. Subgroup analysis also showed that renal survival of patients with proteinuria >3.5 g, M1, E0, S1, T0, and C0 was significantly better in the CS group than in the SC and IT groups. A multivariate model showed that hypertension, serum creatinine, E1 lesion, and T1/T2 lesion remained independent predictors of poor renal survival.

Conclusions: Immunosuppressive therapy does not have further benefit beyond that provided by steroids. Corticosteroids plus optimal supportive care may further be beneficial in treating early-stage IgAN patients in that it could significantly improve the short-term renal outcome.

Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria

BACKGROUND

We aimed to evaluate the effect of immunosuppressant therapy for immunoglobulin A nephropathy (IgAN) patients with mild proteinuria (<1 g/d).

METHODS

We recruited patients with biopsy-proven IgAN from 4 study centers. Patients were followed for more than 1 year or up to the study end point. Clinical indexes, renal pathological data, and treatment information were collected during the follow-up period. IgAN patients with mild proteinuria (<1 g/d at biopsy) were included. Patients were divided into a supportive care group (SC) and an immunosuppressant group (IT). Patients in the SC group received the optimal dose of renin angiotensin system inhibitors (RASi). Patients in the IT group received corticosteroids or immunosuppressant therapy plus RASi. Responses to therapy included complete remission (CR), partial remission (PR), no response (NR), and end stage renal disease (ESRD). A 50% decline in estimated glomerular filtration rate (eGFR) and/or ESRD was the primary end point of this study.

RESULTS

295 patients (36.3% male and 63.7% female) were included in this study and were followed for 49.46 ± 24.35 months. We found a significant difference in estimated glomerular filtration rate, urine protein, mesangial hypercellularity, segmental glomerulosclerosis, cellular or fibrocellular crescents, and glomerulosclerosis between the 2 treatment groups at baseline. At the final follow-up, 224 patients (75.9%) achieved CR, 7 patients (2.4%) achieved PR, 55 patients (18.6%) had NR, and 9 patients (3.1%) reached ESRD. However, no significant differences were observed between the SC and IT groups with respect to CR (76.4% vs 73.5%, P = .659), PR (2.0% vs 4.1%, P = .329), NR (18.3% vs 20.4%, P = .728), and ESRD (3.3% vs 2.0%, P = 1.000). Kidney survival rates were also comparable between the SC and IT groups (93.7% vs 94.1%, P = .808). We observed similar results after subgroup analysis according to chronic kidney disease stages or pathological manifestations. A multivariate model showed that segmental sclerosis (HR 9.55, 95% CI 1.04-88.16, P = .047) and glomerulosclerosis (HR 21.09, 95% CI 1.39-320.53, P = .028) were independent predictors of poor renal survival.

CONCLUSIONS

Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria.

THU0405 SERUM METABOLIC PROFILING ANALYSIS OF GOUT PATIENTS BASED ON UHPLC-Q-TOF/MS

Background:

Gout is a common kind of inflammatory arthritis with metabolic disorders. The detailed pathogenesis of gout remains largely unknown. Metabolomics has become an important tool in detecting the new pathogenesis and biomarkers. However, few studies have focused on the serum metabolic profiling of gout.

Objectives:

The study aims to investigate the metabolic profiling of gout patients with ultra-performance liquid chromatograph quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS), and explore the potential pathological mechanisms and biomarkers.

Methods:

Serum samples from 31 gout patients and 31 healthy controls were analyzed by UPLC-Q-TOF-MS. Principal components analysis (PCA), orthogonal partial least squares-discriminant analysis (OPLS-DA) and Hierarchical clustering analysis were performed to detect different compounds between the two groups. Receiver operating characteristic (ROC) curve analysis and pathway analysis of the different metabolites were conducted.

Results:

A total of 9192 compounds were detected, of which 138 significantly different compounds were selected, according to the criteria of (Variable importance in projection (VIP)>3,P<0.05). Eventually, 96 reliable metabolites matched the HMDB database were confirmed. ROC curve results showed that the area under the curve (AUC) value of 4-hydroxytriazolam for gout was 0.933 (CI95%: 0.875-0.992), yielding a highest AUC value, with the sensitivity of 83.9% and specificity of 93.5%. The pathway analysis results indicated that the significantly different metabolites were mainly involved in “primary bile acid biosynthesis”, “purine metabolism” and “glycerophospholipid metabolism”.

Conclusion:

The serum metabolic profiling in gout patients were significantly different from healthy subjects. 4-hydroxytriazolam was the potential biomarkers. Primary bile acid biosynthesis may be a novel metabolic pathway of gout.

References:

[1]Banoei MM, et al. Metabolomics and Biomarker Discovery in Traumatic Brain Injury. J Neurotrauma, 2018. 35(16): p. 1831-1848.

Disclosure of Interests: :

None declared

AB0931 THE QUALITY OF LIFE IN GOUT PATIENTS WITH ULCERATION OVER TOPHI

Background:

The prevalence of gouty patients with ulcerations over tophi are increasing over time and it has been reported that gouty patients have significantly poor quality of life (QoL) compared to those healthy controls. [1, 2] there is no study on comparison of the QoL in patients with or without ulceration over tophi.

Objectives:

To compare the QoL in gout patients with or without ulcerations over tophi.

Methods:

A total of 79 inpatients with gout who were admitted to Guangdong Second Provincial General Hospital from January 2019 to January 2020 were included. Among them, ulcerations were identified in 28 patients. Short Form-36 Scales (SF-36) were chosen to assess patients. Differences between the groups were tested with Student’s t test or Mann-Whitney U test for continuous variables, and Chi-square tests for categorical variables.

Results:

Of 79 subjects, 74 were male, mean age was 54.23±14.3 years, disease duration was 10.94±7.06 years. Gouty patients had moderate- to high-quality levels in general health, vitality, social functioning, role emotional, and mental health (median: 65, 75, 75, 88, and88, respectively), while had low levels of quality in role physical, and bodily pain (median: 0, and 22, respectively). Patients presenting with ulcerations over tophi had worse scores on five SF-36 domains, the mental component summary (MCS) and the physical component summary (PCS) than gout patients without ulcerations [mean (SD); P < 0.05 for all]: Bodily pain, 30.86(31.59) vs 35.17(33.40); General health, 49.46(27.01) vs 64.17(23.69); Vitality, 57.14(32.53) vs 72.84(26.38); Mental health, 75.4(22.43) vs 83.05(20.96); Reported health transition, 3.58(0.89) vs 3.78(1.42); MCS, 52.62(21.82) vs 66.65(21.44); PCS, 35.85(21.17) vs 46.67(23.86).

Conclusion:

Patients with ulcerations over tophi present much worse QoL compared those without ulcerations. Our study suggests that the presence of ulceration over tophi further deteriorates the QoL in gout patients.

References:

[1]Z. Huang, X. Liu, Y. Liu, et al., Clinical characteristics and risk factors of ulceration over tophi in patients with gout, Int J Rheum Dis, 22 (2019) 1052-1057.

[2]T. Fu, H. Cao, R. Yin, et al., Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study, BMC Musculoskelet Disord, 18 (2017) 429.

Table 1.

Clinical characteristics

VariableTotal (n=79)Non-ulcerations (n=51)Ulcerations (n=28)PvalueMale, n (%)74(93.7)47(92.1)27(96.4)0.462Agea, mean, y54.23±14.3053.96±12.2454.71±17.690.842Body mass indexa, kg/m224.87±3.9725.13±4.0224.40±3.910.444Gout durationa,y10.96±7.0610.04±6.7512.63±7.410.119Maximum Serum uric acid, mg/dL625.5±133.86630.9±124.23614.3±166.430.639Smoking, n (%)38(48.1)23(45.1)15(53.5)0.477Alcohol, n (%)26(32.9)13(25.5)13(46.4)0.072Hypertension, n (%)34(43.0)18(35.3)16(57.1)0.062Diabetes mellitus, n (%)13(16.5)10(19.6)3(10.7)0.281Regular treatment, n(%)3(3.8)3(5.9)0(0)0.971Glucocorticoid abuse, n (%)18(22.8)11(21.5)7(25.0)0.173

aMean (SD).

Table 2.

QoL scores

Median (IQR)Non-ulcerations (n=51), mean (SD)Ulcerations (n=28), mean (SD)PvaluePhysical functionb50(20-80)58.62(32.17)40.89(35.97)0.095Role physicalb0 (0-100)33.03(46.91)17.85(37.17)0.119Bodily painb22(0-62)35.17(33.40)30.86(31.59)0.007General healthb65 (40-80)64.17(23.69)49.46(27.01)0.014Vitalityb75 (50-95)72.84(26.38)57.14(32.53)0.023Social functionb75(38-100)72.55(3.02)60.27(33.85)0.107Role emotionalb88 (68-96)33.98(47.37)15.43(34.45)0.135Mental healthb88 (68-96)83.05(20.96)75.4(22.43)0.007Reported health transition3.78(1.42)3.58(0.89)0.007PCS46.67(23.86)35.85(21.17)0.048MCS66.65(21.44)52.62(21.82)0.007

b(range = 0-100)

Disclosure of Interests:

None declared

THU0450 OPTIMISTIC STATUS ASSOCIATES WITH COMPLIANCE TO URATE-LOWERING THERAPY IN GOUT PATIENTS

Background:

Compliance to urate-lowering therapy (ULT) is poor in gout patients, which contributes to increased frequency of acute gout attacks, deposition of tophi and urate nephropathy [1]. Optimistic status is probably a potential and considerable factor affecting compliance to ULT in gout patients.

Objectives:

To compare optimistic status between gout patients and healthy controls, and also between gout patients with good and poor compliance. Relationship between optimistic status and compliance to ULT, sUA target achievement of gout patients were assessed as well.

Methods:

This was a monocentric and observational study which was performed from August 2018 to December 2019. Adult patients who met the 2015 gout classification criteria were included in this study. The healthy controls were individuals who were free of gout, hyperuricemia and other rheumatic diseases from the physical examination center of our hospital. Demographic data, including age, gender and education were collected from all individuals. Serum uric acid (sUA) were collected from gout patients at enrollment and again after 3 months. Disease duration of gout, visual analogue scale (VAS) of pain were also assessed for gout patients at enrollment. Compliance to ULT was measured using the medication possession ratio (MPR) in the following 3 months. Poor compliance was defined as MPR<0.8 and good compliance was defined as MPR≥0.8. All subjects completed the life orientation test-revised (LOT-R) for optimistic status assessment.

Results:

Five hundred and thirty gout patients and 307 healthy controls matched by age (41.4±12.3 vs. 42.1±9.3 years), gender (male 97.1% vs. 95.1%) and education (college graduated 54.2% vs. 58.0%) were included in this study. Of the 530 gout patients, the mean disease duration was 5.7±4.9 years, and 292 (55.1%) patients’ MPR were lower than 0.8. There was no statistic difference in LOT-R between gout patients and healthy controls (19.0±2.4 vs. 19.2±2.5, P>0.05) (Table 1). Gout patients with poor compliance (MPR<0.8) had higher level of sUA (525.5±138.0 vs. 471.2±152.5 μmol/L, P<0.05), followup sUA (450.1±154.5 vs. 361.6±120.0 μmol/L, P<0.05) and higher LOT-R (19.6±2.6 vs. 17.8±1.7, P<0.05) than those with good compliance (MPR≥0.8). Of the 292 gout patients with poor compliance, there were only 83 (28.4%) patients achieved sUA target after 3 months, and their LOT-R were significantly lower than those did not achieve sUA target (18.8±2.1 vs. 19.6±2.4, P<0.05). Finally, LOT-R correlated positively with sUA (r=0.131, P<0.05) and followup sUA (r=0.09, P<0.05), but negatively with MPR (r=-0.473, P<0.05) of gout patients (Table 2).

Table 1

Demographic and optimistic status of gout patients and healthy controls

VariablesGout patients(n=530)Controls(n=307)PAge (years)41.4±12.342.1±9.30.116Male gender, n (%)511 (96.4)292 (95.1)0.368College graduated, n (%)287 (54.2)178 (58.0)0.312LOT-R19.0±2.419.2±2.50.189

LOT-R:life orientation test-revised

Table 2

Correlation analysis between LOT-R and clinical variables in gout patients

VariablesLOT-RrPAge00.994Disease duration-0.0580.182VAS0.0340.432sUA0.1310.003*Followup sUA0.1260.016*MPR-0.393<0.001*

LOT-R: life orientation test-revised,VAS:visual analogue scale,sUA:serum uric acid,MPR:medication possession ratio

*P<0.05

Conclusion:

Gout patients share similar optimistic status to healthy controls. However, optimistic status relates to compliance to ULT and sUA target achievement of gout patients.

References:

[1]Harrold L R, Andrade S E, Briesacher B A, et al. Adherence with urate-lowering therapies for the treatment of gout. Arthritis research & therapy 2009, 11(2):R46.

Disclosure of Interests: :

None declared

Relationship of adiponectin, leptin, visfatin and IGF-1 in cow's venous blood and venous cord blood with calf birth weight

The Intrauterine fetal development process is complicated and affected by many regulating factors such as maternal nutritional status, transcription factors and adipokines. Adipokines are kinds of active substances secreted by adipose tissue, including more than 50 kinds of molecules. To explore the correlation between calf birth weights and adipokines including adiponectin, leptin, visfatin, and IGF-1 in cows venous and venous cord blood. Fifty-four healthy multiparous Chinese Holstein cows were used; in which, cows with a calf weight less than 40 kg were included in group A (n=9); those with a calf weight between 40 kg~45 kg were included in group B (n=25) and ≥45 kg were included in group C (n=20), venous blood and cord venous blood was collected. An ELISA kit was used to evaluate the concentration of adiponectin, leptin, visfatin, and IGF-1, correlations between index-index and index-calf birth weight were analysed. In both cows venous and cord venous blood, adiponectin, leptin, visfatin, and IGF-1 levels were significantly correlated with each other (p⟨0.01), and levels of these adipokines in venous blood were significantly higher than cord venous blood (p⟨0.01). Adiponectin, leptin, visfatin, and IGF-1 in venous cord blood were positively correlated with calf birth weights, and significantly correlated with calf birth weights respectively (p⟨0.01). Our study showed that adiponectin, leptin, and IGF-1 were found in venous blood and cord venous blood, and adiponectin, leptin, and IGF-1 in venous and cord venous blood potentially inter-regulated each other; adiponectin, leptin, and IGF-1 in venous blood were not significantly correlated with calf birth weights, while adiponectin, leptin, visfatin, and IGF-1 in venous cord blood were significantly correlated with calf birth weights, respectively.

Phase-space matching between bent Laue and flat Bragg crystals

Through phase-space analysis of Dumond diagrams for a flat Bragg crystal, a single bent Laue crystal and a monochromator consisting of double-bent Laue crystals, this work shows that it is possible to match the flat Bragg crystal to both the single-crystal and double-crystal Laue monochromators. The matched system has the advantage that the phase space of the bent crystal's output beam is much larger than that of the flat crystal, making the combined system stable. Here it is suggested that such a matched system can be used at synchrotron facilities to realize X-ray dark-field imaging, analyzer-based imaging and diffraction-enhanced imaging at beamlines using double-Laue monochromators.

Mutation Analysis of Pre-mRNA Splicing Genes PRPF31, PRPF8, and SNRNP200 in Chinese Families with Autosomal Dominant Retinitis Pigmentosa

BACKGROUND

To screen variants in pre-mRNA Splicing genes in 95 Chinese autosomal dominant retinitis pigmentosa (adRP) families.

METHODS

Clinical examination and pedigree analysis were performed. Targeted exome sequencing (TES) and / or Sanger sequencing were performed to detect the variants in genes of Splicing factors and conduct intra-familiar segregation analysis with DNA available. In silico analysis was performed to predict pathogenicity of variants in protein level and in vitro splicing assays were performed to compare splicing variants with their corresponding wildtype about their splicing effect.

RESULTS

In this study, total nine different variants were identified in PRPF31, SNRNP200, and PRPF8 respectively, including six PRPF31 variants [five novel variants 322+1G>A, c.527+2T>G, c.590T>C(p.Leu197Pro), c.1035_1036insGC (p.Pro346Argfs X18), and c.1224dupG (p.Gln409AlafsX66) plus one reported variant c.1060C>T (p.Arg354X)], a recurrent PRPF8 variant c.6930G>T (p.Arg2310Ser), two SNRNP200 variants [one heterozygous and homozygous SNRNP200 recurrent variant c.3260G>A (p.Ser1087Leu), and a reported heterozygous c.2042G>A(p.Arg681His)]. In family 20009, incomplete penetrance was observed. A novel PRPF31 missense variant c.590T>C (p.Leu197Pro) was predicted to be pathogenic in protein level via in silico analysis and in vitro splicing assay demonstrated that two novel splicing PRPF31 variants c.322+1G>A and c.527+2T>G affect splicing compared with the wildtype.

CONCLUSIONS

In our studies, RP-causing variants of pre-mRNA Splicing genes (PRPF31, PRPF8 and SNRNP200) were identified in nine of the ninety-five adRP families respectively, which extend the spectra of RP variant and phenotype. And we provide the first example that SNRNP200-related RP can be caused by both heterozygous and homozygous variants of this gene.

The Clinicopathological Characteristics of Henoch-Schönlein Purpura Nephritis with Presentation of Nephrotic Syndrome

BACKGROUND

Henoch-Schönlein purpura nephritis (HSPN) is a common vasculitis involving the kidneys, with a lower incidence in adults. Meanwhile, nephrotic syndrome (NS) can appear in HSPN. However, the clinicopathological features and renal outcome of adult-onset HSPN presenting with NS (NS-HSPN) have not been well clarified.

METHODS

A total of 191 HSPN patients were prospectively analyzed and comparisons were made between NS-HSPN and non-NS-HSPN. Multivariate Cox regression analysis was carried out to find the unfavorable factors of renal outcome of NS-HSPN.

RESULTS

Among the 191 patients, 44 (23.0%) had NS-HSPN. Apart from edema and abdominal pain, patients with NS-HSPN tended to have lower levels of erythrocytes and hemoglobulin in blood as well as a greater number of erythrocytes in urine (p < 0.05). Mesangial proliferation was the most common pathological lesion in HSPN and the rates of crescent formation were significantly different, with 54.5% in NS-HSPN and 33.3% in non-NS-HSPN (p < 0.05). Notably, 18.2 and 4.8% of patients reached the composite endpoints in the NS-HSPN and non-NS-HSPN groups, respectively (p < 0.05), demonstrating that NS-HSPN patients were more likely to progress to end-stage renal disease and had a worse outcome. We also found that hypertension, estimated glomerular filtration rate (eGFR), cystatin, and tubular atrophy/interstitial fibrosis (HR > 1, p < 0.05) at onset were correlated with adverse outcome in NS-HSPN.

CONCLUSION

NS-HSPN had more severe clinicopathological manifestations and poorer prognosis. The adverse predictors of NS-HSPN principally depend on clinicopathological presentation rather than on different therapies, and hypertension, eGFR, cystatin, and tubular atrophy/interstitial fibrosis can serve as independent risk factors in NS-HSPN.

Comparison of microRNAs in adipose and muscle tissue from seven indigenous Chinese breeds and Yorkshire pigs

Elucidation of the pig microRNAome is essential for interpreting functional elements of the genome and understanding the genetic architecture of complex traits. Here, we extracted small RNAs from skeletal muscle and adipose tissue, and we compared their expression levels between one Western breed (Yorkshire) and seven indigenous Chinese breeds. We detected the expression of 172 known porcine microRNAs (miRNAs) and 181 novel miRNAs. Differential expression analysis found 92 and 12 differentially expressed miRNAs in adipose and muscle tissue respectively. We found that different Chinese breeds shared common directional miRNA expression changes compared to Yorkshire pigs. Some miRNAs differentially expressed across multiple Chinese breeds, including ssc-miR-129-5p, ssc-miR-30 and ssc-miR-150, are involved in adipose tissue function. Functional enrichment analysis revealed that the target genes of the differentially expressed miRNAs are associated mainly with signaling pathways rather than metabolic and biosynthetic processes. The miRNA-target gene and miRNA-phenotypic traits networks identified many hub miRNAs that regulate a large number of target genes or phenotypic traits. Specifically, we found that intramuscular fat content is regulated by the greatest number of miRNAs in muscle tissue. This study provides valuable new candidate miRNAs that will aid in the improvement of meat quality and production.

Serum IgG Antibodies against Periodontal Microbes and Cancer Mortality

INTRODUCTION

Periodontitis is a chronic inflammatory condition initiated by microorganisms and is positively linked to systemic conditions such as cancer, cardiovascular disease, and diabetes mellitus.

OBJECTIVES

To prospectively investigate associations between empirically derived clusters of IgG antibodies against 19 selected periodontal microorganisms and cancer mortality in a representative sample of the US population.

METHODS

We evaluated 6,491 participants aged ≥40 y from the Third National Health and Nutrition Examination Survey (1988 to 1994), who had complete data on IgG antibody titers against 19 selected periodontal microorganisms and were free of cardiovascular disease and cancer. In a prior study, antibodies were categorized into 4 mutually exclusive groups via cluster analysis: red-green, orange-red, yellow-orange, and orange-blue. Cluster scores were estimated by summing z scores of the antibody titers making up each cluster. Participants were followed up to death until December 31, 2011. Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% CIs for all-cancer mortality by tertiles of cluster scores.

RESULTS

During follow-up for a median of 15.9 y, there were 2,702 deaths (31.3%), including 631 cancer-related deaths (8.1%). After adjusting for multiple confounders, the orange-blue cluster was inversely associated with cancer mortality (tertile 2 vs. tertile 1: HR = 0.67, 95% CI = 0.54 to 0.84; tertile 3 vs tertile 1: HR = 0.62, 95% CI = 0.46 to 0.84). The association between the yellow-orange cluster and all-cancer mortality was also inverse but not significant, and the orange-red cluster and the red-green cluster were not associated with all-cancer mortality.

CONCLUSIONS

Antibodies against Eubacterium nodatum and Actinomyces naeslundii may be novel predictors of cancer mortality. If further studies establish a causal relationship between these antibodies and cancer mortality, they could be targets to prevent possible systemic effects of periodontal disease with potential interventions to raise their levels.

KNOWLEDGE TRANSFER STATEMENT

Periodontal antibodies against Eubacterium nodatum and Actinomyces naeslundii were inversely associated with cancer mortality among adults followed up for an average of 16 y. Periodontal antibodies may predict cancer mortality.

RNA-seq of circular RNAs identified circPTPN22 as a potential new activity indicator in systemic lupus erythematosus

Background

Circular RNAs (circRNAs) are possible biomarkers for many diseases, but the knowledge of circRNAs in the peripheral blood mononuclear cells (PBMCs) of patients with systemic lupus erythematosus (SLE) remains limited. This study aimed to assess the expression of circRNAs in PBMCs from patients with SLE and healthy individuals by RNA sequencing (RNA-seq).

Methods

In total, 128 circRNAs were significantly differentially expressed including 39 upregulated and 89 downregulated circRNAs in four new-onset SLE patients compared with three healthy controls. After verification of the four candidate circRNAs in 49 patients with SLE and 37 controls using quantitative real-time polymerase chain reaction (qRT-PCR) assays, a previously undescribed circRNA with potential translation activity, circPTPN22, was selected to confirm its clinical significance.

Results

Bioinformatics analysis demonstrated that the parent gene of circPTPN22 was protein tyrosine phosphatase non-receptor type 22 (PTPN22), a potent regulator of T cell activation. The downregulation of circPTPN22 in patients with SLE was strongly negatively correlated with their Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. circRNA-miRNA-mRNA co-expression network analysis indicated a correlation between circPTPN22 and the miRNAs and mRNAs related to immunological regulation including the development of SLE. Patients with higher SLEDAI scores had lower circPTPN22 expression levels, and long-term hormone treatment significantly increased circPTPN22 levels. Receiver operating characteristic curve analysis indicated that circPTPN22 has good diagnostic value for SLE.

Conclusion

Our data demonstrated the aberrant expression of circRNAs in patients with SLE compared with healthy controls; circPTPN22 might function as a diagnostic and disease severity indicator in SLE.

Abstract P6-03-01: Development of patient-derived xenograft tumor model with organ-specific metastatic potential for evaluation of new therapeutics for hormone receptor-positive advanced breast cancer

Background: Breast cancer (BC) is a heterogeneous disease with most common metastatic sites of liver, lung, brain, and bone. Endocrine resistance in hormone receptor-positive (HR+) advanced BC (ABC) cancer is a clinical challenge. ESR1 mutations are a key mechanism in acquired resistance, primarily occurs after exposure to endocrine therapy such as aromatase inhibitors but also selective estrogen modulators and degraders (i.e. Tamoxifen and Fulvestrant). Circulating tumor cells (CTCs) enumeration is a prognostic biomarker in ABC but the relation between the onset of ESR1 mutations and CTCs status is still unclear. Aim of this project is to define the clinical behavior of ESR1 mutated ABC in terms of metastasizing potential, through CTC enumeration and pattern; and to establish ESR1 mutated HR+ ABC PDX models able to recapitulate these characteristics.

Methods: CTCs and circulating tumor DNA (ctDNA) were characterized in 55 HR+ ABC patients. ESR1 mutations status from 55 patient plasma cell-free DNA were generated using Guardant Next Generation Sequencing. Samples were also examined for numbers of CTCs by CellSearch. Association of ESR1 mutations with sites of distant organ metastasis and with CTC enumeration was analyzed by Chi square test and Kruskal–Wallis test, respectively. In preclinical model development, six samples of pleural effusion-derived tumor cells from Stage IV HR+ ABC patients were collected to establish HR+ ABC with ESR1 mutation PDX tumor model and its derived 3D organoid/spheroid cultures

Results: ESR1 mutations were identified in 10 out of 55 patients (4 Y537S variant and 3 D538G variant, 4 other variants, 1 patient with both variants). In 55 patients, 72 visceral vs 27 bone metastatic incidences were observed; the data indicated 9 observed vs 4.5 expected in ESR1 mutated and 16 observed vs 20.5 expected in wild type (WT) (P=0.003) for liver metastasis; 10 observed vs 7.1 expected in ESR1 mutated and 29 observed vs 31.9 expected in WT (P=0.026) for bone metastasis. Further liver metastasis analysis of individual hot spot mutation site indicated 4 observed vs 1.8 expected in Y537S and 21 observed vs 23.2 expected in WT (P=0.037); and 3 observed vs 1.4 expected in D538G and 22 observed vs 23.6 expected in wild type (P=0.088). The analysis of correlation/distribution between CTCs numbers and ESR1 mutated suggested CTCs median of 13 (IQR 7-49) in ESR1 mutated and 0 (IQR 0-4) in WT HR+ patients (P=0.0044). Four ABC PDX tumor models were developed in immunodeficient NSG female mice demonstrated by pathology to have highly heterogeneous characteristics and metastatic features of the origin patient tumor, in particular, breast fat pad xenografted PDX tumor can result in metastasis to liver and lung tissue. In addition, two patient 3D tumor organoid/spheroid cultures were successfully established.

Conclusions: ESR1 mutated ABC is associated with more aggressive (Stage IV) clinical behavior demonstrated by association with visceral metastases and CTCs detection. ESR1-mutated PDX models recapitulate aggressive features of the disease and can be used for preclinical testing of novel agents in endocrine resistant disease.

Citation Format: Qiang W, Zhong Z, Gerratana L, Zhang Y, Zhang Q, Gursel D, Wei J-J, Bleher R, James C, O'Halloran T, Cristofanilli M. Development of patient-derived xenograft tumor model with organ-specific metastatic potential for evaluation of new therapeutics for hormone receptor-positive advanced breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-03-01.

The impact of timing of maternal influenza immunization on infant antibody levels at birth

Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available.

[Role of Testin in nasopharyngeal squamous cancer with high ability of metastasis]

Objective:To explore the influence and regulatory mechanism of TES gene on proliferation and migration of nasopharyngeal squamous cancer(NSPC) 5-8F cell.Method:DNA fragment encoding TES was obtained by RT-PCR method from the human highly metastatic nasopharyngeal squamous carcinoma cell line 5-8F. we identified the recombinant plasmid pEGFP-N1-TES by RT-PCR and DAN sequencing. we stablely transfected the pEGFP-N1-TES into the human highly metastatic nasopharyngeal squamous carcinoma cell line 5-8F, and detected the expression of TES by the RT-PCR and Western-blot method. And detected the impact of 5-8F cells transfection by flow cytometry and scratch tests.Result:Flow cytometry analysis showed that the apoptotic in 5-8F/pEGFP- N1-TES was significantly higher than non-transected TES and 5-8F/pEGFP-N1,and the differences were statistically significant(P<0.05).Cell scratch experiments showed that the 5-8F/pEGFP-N1-TES group cell migration rate was obviously lower than nontransected TES and 5-8F/pEGFP-N1 group in the first 12 h, 24 h and 48 h.The difference was significant(P<0.01).Conclusion:The stable transfectant cell model was established successfully. TES in vitro could significantly increase apoptosis and reduce the athletic ability. And thus TES gene might be a novel candidate of tumor-suppressor.

Localized Control of Curie Temperature in Perovskite Oxide Film by Capping-Layer-Induced Octahedral Distortion

With reduced dimensionality, it is often easier to modify the properties of ultrathin films than their bulk counterparts. Strain engineering, usually achieved by choosing appropriate substrates, has been proven effective in controlling the properties of perovskite oxide films. An emerging alternative route for developing new multifunctional perovskite is by modification of the oxygen octahedral structure. Here we report the control of structural oxygen octahedral rotation in ultrathin perovskite SrRuO_{3} films by the deposition of a SrTiO_{3} capping layer, which can be lithographically patterned to achieve local control. Using a scanning Sagnac magnetic microscope, we show an increase in the Curie temperature of SrRuO_{3} due to the suppression octahedral rotations revealed by the synchrotron x-ray diffraction. This capping-layer-based technique may open new possibilities for developing functional oxide materials.

Atomically Precise Lateral Modulation of a Two-Dimensional Electron Liquid in Anatase TiO2 Thin Films

Engineering the electronic band structure of two-dimensional electron liquids (2DELs) confined at the surface or interface of transition metal oxides is key to unlocking their full potential. Here we describe a new approach to tailoring the electronic structure of an oxide surface 2DEL demonstrating the lateral modulation of electronic states with atomic scale precision on an unprecedented length scale comparable to the Fermi wavelength. To this end, we use pulsed laser deposition to grow anatase TiO₂ films terminated by a (1 × 4) in-plane surface reconstruction. Employing photostimulated chemical surface doping we induce 2DELs with tunable carrier densities that are confined within a few TiO₂ layers below the surface. Subsequent in situ angle-resolved photoemission experiments demonstrate that the (1 × 4) surface reconstruction provides a periodic lateral perturbation of the electron liquid. This causes strong backfolding of the electronic bands, opening of unidirectional gaps and a saddle point singularity in the density of states near the chemical potential.