[Identification of key genes in Wilms tumor based on high-throughput RNA sequencing and their impacts on prognosis and immune responses]

OBJECTIVE

To identify the key genes differentially expressed in Wilms tumor and analyze their potential impacts on prognosis and immune responses of the patients.

METHODS

High-throughput RNA sequencing was used to identify the differentially expressed mRNAs in clinical samples of Wilms tumor and paired normal tissues, and their biological functions were analyzed using GO, KEGG and GSEA enrichment analyses. The hub genes were identified using STRING database, based on which a prognostic model was constructed using LASSO regression. The mutations of the key hub genes were analyzed and their impacts on immunotherapy efficacy was predicted using the cBioPortal platform. RT-qPCR was used to verify the differential expressions of the key hub genes in Wilms tumor.

RESULTS

Of the 1612 differentially expressed genes identified in Wilms tumor, 1030 were up-regulated and 582 were down-regulated, involving mainly cell cycle processes and immune responses. Ten hub genes were identified, among which 4 genes (TP53, MED1, CCNB1 and EGF) were closely related to the survival of children with Wilms tumor. A 3-gene prognostic signature was constructed through LASSO regression analysis, and the patients stratified into with high- and low-risk groups based on this signature had significantly different survival outcomes (HR=1.814, log-rank P=0.002). The AUCs of the 3-, 5- and 7-year survival ROC curves of this model were all greater than 0.7. The overall mutations in the key hub genes or the individual mutations in TP53/CCNB1 were strongly correlated with a lower survival rates, and a high TP53 expression was correlated with a poor immunotherapy efficacy. RT-qPCR confirmed that the key hub genes had significant differential expressions in Wilms tumor tissues and cells.

CONCLUSION

TP53 gene plays an important role in the Wilms tumor and may potentially serve as a new immunotherapeutic biomarker as well as a therapeutic target.

Norovirus outbreaks in hospitals in China: a systematic review

BACKGROUND

Norovirus outbreaks in hospitals can potentially impair patient care and result in significant financial expenses. There is currently limited information on hospital norovirus outbreaks in the Chinese mainland.

AIM

To systematically review the published literature to describe the characteristics of norovirus outbreaks in Chinese mainland hospitals to facilitate prompt identification and control of outbreaks.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis standards. Databases including PubMed, Web of Science, and Chinese Journals Online databases (China National Knowledge Infrastructure (CNKI), Chinese Wan Fang digital database (WANFANG) were searched from inception to July 18th, 2022.

FINDINGS

A total of 41 norovirus Chinese hospital outbreaks occurring before July 18th, 2022 were reported in 32 articles. Most reported outbreaks were from Shanghai and Beijing, and occurred in December and January. Cases were mainly adults. The male:female ratio was 1.22:1. The majority of cases in norovirus outbreaks were hospitalized patients (56.82%); medical staff were affected in 15 outbreaks. Norovirus outbreaks occurred in both private and public hospitals, and in secondary and tertiary care centres, and occurred mainly in internal medicine and geriatric departments. Person-to-person transmission was the primary transmission mode and GII was more prevalent.

CONCLUSION

Norovirus outbreaks in hospitals can affect both patients and healthcare workers, sometimes causing serious financial losses. In order to have a more complete understanding of the disease burden caused by norovirus outbreaks, surveillance needs to be established in hospitals.

[Epidemiological and clinical characteristics of human ocular helaziasis in China from 2011 to 2022 based on bibliometrics]

OBJECTIVE

To understand the clinical and epidemiological characteristics of human ocular thelaziasis patients in China.

METHODS

Case reports regarding human ocular thelaziasis cases in China were retrieved in international and national electronic databases, including CNKI, VIP, CBM, Traditional Chinese Medical Literature Analysis and Retrieval System, Wanfang Database, PubMed and Web of Science from 2011 to 2022. Patients' gender, age, clinical symptoms, treatment, recurrence, site of infections, time of onset, affected eye, affected sites, number of infected Thelazia callipaeda, sex of T. callipaeda and source of infections were extracted for descriptive analyses.

RESULTS

A total of 85 eligible publications were included, covering 101 cases of human ocular thelaziasis, including 57 males (56.44%) and 44 females (43.56%) and aged from 3 months to 85 years. The main clinical manifestations included foreign body sensation (56 case-times, 22.49%), eye itching (38 case-times, 15.26%), abnormal or increased secretions (36 case-times, 14.46%), tears (28 case-times, 11.24%) and eye redness (28 case-times, 11.24%), and conjunctival congestion (50 case-times, 41.67%) was the most common clinical sign. The most common main treatment (99/101, 98.02%) was removal of parasites from eyes using ophthalmic forceps, followed by administration with ofloxacin and pranoprofen. In publications presenting thelaziasis recurrence, there were 90 cases without recurrence (97.83%) and 2 cases with recurrence (2.17%). Of all cases, 51.96% were reported in four provinces of Hubei, Shandong, Sichuan, Hebei and Henan, and ocular thelaziasis predominantly occurred in summer (42.19%) and autumn (42.19%). In addition, 56.45% (35/62) had a contact with dogs.

CONCLUSIONS

The human thelaziasis cases mainly occur in the continental monsoon and subtropical monsoon climate areas such as the Yellow River and the Yangtze River basin, and people of all ages and genders have the disease, with complex clinical symptoms and signs. Personal hygiene is required during the contact with dogs, cats and other animals, and individual protection is required during outdoor activities to prevent thelaziasis.

[Evaluation of the clinical manifestations of COVID-19 in patients with aplastic anemia undergoing immunosuppressive therapy: a prospective cohort study (NICHE)]

Objective: To investigate the clinical features of coronavirus disease 2019 (COVID-19) in patients with aplastic anemia (AA) undergoing immunosuppressive therapy (IST) . Methods: In this prospective cohort study, we collected the demographic and clinical data of patients with AA and COVID-19 from December 1, 2022, to January 31, 2023. We described the clinical features of COVID-19 among patients with AA and evaluated the effects of IST on the signs and severity of COVID-19. Results: A total of 170 patients with AA and COVID-19 were included. The common early symptoms, including fever, dizziness or headache, muscle or body aches, and sore throat, disappeared within 1-2 weeks. Approximately 25% of the patients had persistent fatigue within 2 weeks. Many patients experienced cough after an initial 1-3 days of infection, which lasted for more than 2 weeks. There were no differences in the duration of total fever episodes and maximum body temperature when patients were stratified according to whether or not they underwent IST, by IST duration, or by use of anti-lymphocyte globulin (ALG) (P>0.05). No differences were observed in the occurrence of symptoms in either the early or recovery stages when patients with AA were stratified according to whether or not they underwent IST, or by IST duration (P>0.05). However, patients who received ALG had fewer fever episodes within 1 week after infection (P=0.035) and more sore throat episodes within 2 weeks after infection (P=0.015). There were no other significant differences in clinical symptoms between patients who did and patients who did not receive ALG (P>0.05) . Conclusion: The majority of patients with AA and COVID-19 recovered within 2 weeks of noticing symptoms when treated with IST.

[Y-shaped osteotomy in the apical vertebra for treating congenital complex rigid scoliosis:at least 2-year follow-up]

Objective: To investigate the clinical outcome of the coronal Y-shaped osteotomy in the apical vertebra for treating congenital complex rigid scoliosis. Methods: A retrospective analysis was conducted on 66 cases who underwent Y-shaped osteotomy treatment for congenital complex rigid scoliosis in the uppermost vertebra at the Department of Orthopedics,the Second Hospital of Shanxi Medical University from June 2007 to August 2020. There were 19 males and 47 females,with an age of (13.1±5.3) years(range:2 to 30 years).Classification of congenital scoliosis:25 cases (37.9%) were incomplete,13 cases (19.7%) were dysarthritic,and 28 cases (42.4%) were mixed. There were 25 cases (37.9%) with thoracic or rib malformations. 45 cases (68.2%) were complicated with spinal cord malformation.The main radiological indicators included Cobb angle of the curvature,Cobb angle of the local bend,apical vertebral translation (AVT),trunk shift (TS),thoracic trunk shift (TTS),radiographic shoulder height (RSH),coronal balance and sagittal vertebral axis. The preoperative,postoperative immediate,and last follow-up radiological indicators were collected and the operation time,blood loss,hospitalization time,and operation-related complications were recorded. Data were compared by repeated measure ANOVA and paired-t test. Results: All patients underwent surgery successfully. The duration of the first surgery was (221.4±52.8) minutes,and the blood loss during the first surgery was (273.2±41.8) ml. The length of the first hospital stay was (8.8±1.7) days.Unilateral fixation was performed in 19 cases (28.8%),while bilateral fixation was performed in 47 cases (71.2%). The fused segments were 7.5±2.9,and the vertebral pedicle screw density was (68.5±20.6)%. The follow-up time for the 66 patients was (36.7±17.0) months(range:24 to 102 months).The main curve Cobb Angle was improved from (58.5±18.9)°before surgery to (21.1±11.8)°after surgery,and was (23.6±15.3) ° at the last follow-up(F=273.957,P<0.01),with a correction rate of 66.2%. Segmental curve Cobb Angle was improved from (47.9±18.0)° to (16.0±11.3)° after surgery,and was (16.8±12.8) °at the last follow-up (F=270.483,P<0.01)with a correction rate of 69.2%. The AVT,TS,TTS and RSH values improved significantly at the final follow-up (all P<0.05),while coronal balance and sagittal vertical axis were maintained without significant differences between pre-operation and post-operation(both P>0.05). A total of 5 patients underwent staged operation,all of which were residual scoliosis aggravated after the first stage of orthosis operation and had good prognosis after the second stage of operation. Conclusions: Y-shaped osteotomy for the treatment of congenital rigid scoliosis results in good clinical and radiological outcomes without serious complications. This procedure can be considered as an option for the treatment of congenital complex rigid scoliosis.

GREM1 signaling in cancer: tumor promotor and suppressor?

GREMLIN1 (GREM1) is member of a family of structurally and functionally related secreted cysteine knot proteins, which act to sequester and inhibit the action of multifunctional bone morphogenetic proteins (BMPs). GREM1 binds directly to BMP dimers, thereby preventing BMP-mediated activation of BMP type I and type II receptors. Multiple reports identify the overexpression of GREM1 as a contributing factor in a broad range of cancers. Additionally, the GREM1 gene is amplified in a rare autosomal dominant inherited form of colorectal cancer. The inhibitory effects of GREM1 on BMP signaling have been linked to these tumor-promoting effects, including facilitating cancer cell stemness and the activation of cancer-associated fibroblasts. Moreover, GREM1 has been described to bind and signal to vascular endothelial growth factor receptor (VEGFR) and stimulate angiogenesis, as well as epidermal and fibroblast growth factor receptor (EGFR and FGFR) to elicit tumor-promoting effects in breast and prostate cancer, respectively. In contrast, a 2022 report revealed that GREM1 can promote an epithelial state in pancreatic cancers, thereby inhibiting pancreatic tumor growth and metastasis. In this commentary, we will review these disparate findings and attempt to provide clarity around the role of GREM1 signaling in cancer.

Impact of coronary artery disease in patients with hypertrophic cardiomyopathy

BACKGROUND

Atherosclerotic coronary artery disease (CAD) often occurs concurrently with hypertrophic cardiomyopathy (HCM). However, the influence of concomitant CAD has not been fully assessed in patients with HCM.

METHODS

Invasive or computed tomography coronary angiography was performed in 461 patients with HCM at our hospital to determine the presence and severity of CAD from March 2010 to April 2022. The primary end points were all-cause, cardiovascular, and sudden cardiac deaths. The survival of HCM patients with severe CAD was compared with that of HCM patients without severe CAD.

RESULTS

Of 461 patients with HCM, 235 had concomitant CAD. During the median (interquartile range) follow-up of 49 (31-80) months, 75 patients (16.3%) died. The 5-year survival estimates were 64.3%, 82.5%, and 86.0% for the severe, mild-to-moderate, and no-CAD groups, respectively (log-rank, p = 0.010). Regarding the absence of cardiovascular death, the 5-year survival estimates were 68.5% for patients with severe CAD, 86.4% for patients with mild-to-moderate CAD, and 90.2% for HCM patients with no CAD (log-rank, p = 0.001). In multivariate analyses, severe CAD was associated with all-cause and cardiovascular death after adjusting for age, left ventricular ejection fraction, hypertension, and atrial fibrillation.

CONCLUSIONS

This study showed a worse prognosis among HCM patients with severe CAD than among HCM patients without severe CAD. Therefore, timely recognition of severe CAD in HCM patients and appropriate treatment are important.

Applying machine learning methods for the analysis of two-dimensional mass spectra

In a measurement of isomeric yield-ratios in fission, the Phase-Imaging Ion-Cyclotron-Resonance technique, which projects the radial motions of ions in the Penning trap (JYFLTRAP) onto a position-sensitive micro-channel plate detector, has been applied. To obtain the yield ratio, that is the relative population of two states of an isomer pair, a novel analysis procedure has been developed to determine the number of detected ions in each state, as well as corrections for the detector efficiency and decay losses. In order to determine the population of the states in cases where their mass difference is too small to reach full separation, a Bayesian Gaussian Mixture model was implemented. The position-dependent efficiency of the micro-channel plate detector was calibrated by mapping it with 133 Cs+ ions, and a Gaussian Process was trained with the position data to construct an efficiency function that could be used to correct the recorded distributions. The obtained numbers of counts of excited and ground-state ions were used to derive the isomeric yield ratio, taking into account decay losses as well as feeding from precursors.

[Evaluation of the clinical efficacy of minimally invasive endoscopic surgery in the treatment of isolated non-syndromic sagittal synostosis in infants]

The current study aimed to evaluate the early efficacy in infants with isolated non-syndromic sagittal synostosis who underwent minimally invasive endoscopic-assisted surgery. The clinical data of infants with isolated non-syndromic sagittal synostosis who were admitted to the Department of Neurosurgery of the Children's Hospital of Nanjing Medical University and underwent endoscopic-assisted surgery from October 2018 to December 2021 were retrospectively analyzed. All the infants underwent minimally invasive endoscopic-assisted surgery, and were treated with supine sleeping position after surgery. Computer-aided reconstruction technique was used to reconstruct and measure the thin-slice CT scan images of the head before and 3 months after surgery, and the differences in cranial index (CI), cranial cavity volume and angle drawn between the cranial vertex, nasion, and opisthocranion (VNO angle) of preoperative and postoperative groups were analyzed. A total of 103 infants were included in the final analysis, including 85 males and 18 females. The age at surgery was (2.1±0.8) months, and the weight was (6.1±0.9) kg. The postoperative CI was (84±6)%, which increased obviously compared with the pre-operation [(70±5)%] (P<0.001). The cranial volume of post-operation was (947±130) cm³, which was larger than that of the pre-operation [(748±104) cm³] (P<0.001). The VNO angle after surgery was (45±4)°, which showed a significant reduction compared with the pre-operation [(55±4)°] (P<0.001). The correction of head shape was satisfactory. For the treatment of sagittal synostosis in infants, minimally invasive endoscopic-assisted surgery is safe and effective, and in the case of switching from an auxiliary helmet to a supine position, the postoperative correction efficacy of head shape is better.

[CD5L is elevated in the serum of patients with candidemia and promotes disease progression in mouse models]

OBJECTIVE

To investigate the changes of CD5L levels in patients with candidemia and explore the role of CD5L in progression of candidemia.

METHODS

Twenty healthy control individuals, 27 patients with bacteremia and 35 patients with candidemia were examined for serum CD5L levels using ELISA, and the correlations of CD5L level with other serological indicators were analyzed. A C57BL/6 mouse model of candidemia induced by intravenous injection of Candida albicans were treated with intraperitoneal injection of recombinant CD5L protein, and renal histopathological and serological changes were analyzed to assess renal injures. The effects of CD5L treatment on general condition, fungal burden, of survival of the mice were observed, and the changes in serum IL-6 and IL-8 levels of the mice were detected using ELISA.

RESULTS

CD5L levels were significantly elevated in patients with candidemia and positively correlated with WBC, BDG, Scr and PCT levels. The mouse model of candidemia also showed significantly increased serum and renal CD5L levels, and CD5L treatment significantly increased fungal burden in the renal tissue, elevated IL-6 and IL-8 levels in the serum and kidney, aggravated renal tissue damage, and reduced survival rate of candidemia mice.

CONCLUSION

Serum CD5L levels are increased in patients with candidemia, and treatment with CD5L aggravates candidemia in mouse models.

[Clinical features and long-term prognosis of diabetic patients with low or intermediate complexity coronary artery disease post percutaneous coronary intervention]

Objective: To investigate the clinical features and long-term prognostic factors of diabetic patients with low or intermediate complexity coronary artery disease (CAD) post percutaneous coronary intervention (PCI). Methods: This was a prospective, single-centre observational study. Consecutive diabetic patients with SYNTAX score (SS)≤32 undergoing PCI between January and December 2013 in Fuwai hospital were included in this analysis. The patients were divided into two groups based on SS, namely SS≤22 group and SS 23-32 group. Multivariate Cox regression analysis was performed to identify independent factors related to poor 5-year prognosis. The primary outcomes were cardiac death and recurrent myocardial infarction, the secondary outcomes were all cause death and revascularization. Results: Of the 3 899 patients included in the study, 2 888 were men (74.1%); mean age was 59.4±9.8 years. There were 3 450 patients in the SS≤22 group and 449 patients in the SS 23-32 group. Compared with SS≤22 group, the incidence of revascularization was higher in SS 23-32 group (18.9% (85/449) vs. 15.2% (524/3450), log-rank P=0.019). There was no significant difference in all-cause death, cardiac death and recurrent myocardial infarction between the two groups (log-rank P>0.05). Multivariate Cox regression analysis showed that age (HR=1.05, 95%CI 1.02-1.08, P<0.001), chronic obstructive pulmonary disease (HR=3.12, 95%CI 1.37-7.07, P=0.007) and creatinine clearance rate (CCr)<60 ml/min (HR=3.67, 95%CI 2.05-6.58, P<0.001) were independent risk factors for 5-year cardiac death, while left ventricular ejection fraction (HR=0.94, 95%CI 0.91-0.96, P<0.001) was a protective factor. Previous PCI (HR=2.04, 95%CI 1.38-3.00, P<0.001), blood glucose level≥11.1 mmol/L on admission (HR=2.49, 95%CI 1.32-4.70, P=0.005) and CCr<60 ml/min (HR=1.85, 95%CI 1.14-2.99, P=0.012) were independent risk factors for 5-year recurrent myocardial infarction. The SS of 23-32 was independently associated with risk of revascularization (HR=1.54, 95%CI 1.09-2.16, P=0.014), after adjusting for residual SS. Residual SS was not a risk factor for 5-year prognosis. Conclusions: In diabetic patients with low-or intermediate complexity CAD, SS 23-32 is associated with increased risk of 5-year revascularization; the clinical characteristics of the patients are associated with the long-term mortality and recurrent myocardial infarction, but not related to revascularization.

Predicting Hospital Readmissions in Patients Receiving Novel-Dose Sacubitril/Valsartan Therapy: A Competing-Risk, Causal Mediation Analysis

Backgrounds: Our study aimed to identify and predict patients with heart failure (HF) taking novel-dose Sacubitril/Valsartan (S/V) at risk for all-cause readmission, as well as investigate the possible role of left ventricular reverse remodeling (LVRR). Methods and results: There were 464 patients recruited from December 2017 to September 2021 in our hospital with a median follow-up of 660 days (range, 17-1494). Competing risk analysis with Gray's Test showed statistically significant differences in all-cause readmission (p-value< .001) across the three different dose groups. Models 1 and 2 were developed based on the results of univariable competing risk analysis, least absolute shrinkage and selection operator approach, backward stepwise regression, and multivariable competing risk analysis. The internal verification (data-splitting method) indicated that Model 1 had better discrimination, calibration, and clinical utility. The corresponding nomogram showed that patients aged 75 years and above, or taking the lowest-dose S/V (≤50 mg twice a day), or diagnosed with ventricular tachycardia, or valvular heart disease, or chronic obstructive pulmonary disease, or diabetes mellitus were at the highest risk of all-cause readmission. In the causal mediation analysis, LVRR was considered as a critical mediator that negatively affected the difference of novel-dose S/V in readmission. Conclusions: A significant association was detected between novel-dose S/V and all-cause readmission in HF patients, in part negatively mediated by LVRR. The web-based nomogram could provide individual prediction of all-cause readmission in HF patients receiving novel-dose S/V. The effects of different novel-dose S/V are still needed to be explored further in the future.

Utility of trio-based prenatal exome sequencing incorporating splice-site and mitochondrial genome assessment in pregnancies with fetal ultrasound anomalies: prospective cohort study

OBJECTIVE

To evaluate the utility of trio-based prenatal exome sequencing (pES), incorporating splice-site and mitochondrial genome assessment, in the prenatal diagnosis of fetuses with ultrasound anomalies and normal copy-number variant sequencing (CNV-seq) results.

METHODS

This was a prospective study of 90 ongoing pregnancies with ultrasound anomalies that underwent trio-based pES after receiving normal CNV-seq results, from September 2020 to November 2021, in a single center in China. By using pES with a panel encompassing exome coding and splicing regions as well as mitochondrial genome for fetuses and parents, we identified the underlying genetic causes of fetal anomalies, incidental fetal findings and parental carrier status. Information on pregnancy outcome and the impact of pES findings on parental decision-making was collected.

RESULTS

Of the 90 pregnancies included, 28 (31.1%) received a diagnostic result that could explain the fetal ultrasound anomalies. The highest diagnostic yield was noted for brain abnormalities (3/6 (50.0%)), followed by hydrops (4/9 (44.4%)) and skeletal abnormalities (13/34 (38.2%)). Collectively, 34 variants of 20 genes were detected in the 28 diagnosed cases, with 55.9% (19/34) occurring de novo. Variants of uncertain significance (VUS) associated with fetal phenotypes were detected in six (6.7%) fetuses. Interestingly, fetal (n = 4) and parental (n = 3) incidental findings (IFs) were detected in seven (7.8%) cases. These included two fetuses carrying a de-novo likely pathogenic (LP) variant of the CIC and FBXO11 genes, respectively, associated with neurodevelopmental disorders, and one fetus with a LP variant in a mitochondrial gene. The remaining fetus presented with unilateral renal dysplasia and was incidentally found to carry a pathogenic PKD1 gene variant resulting in adult-onset polycystic kidney, which was later confirmed to be inherited from the mother. In addition, parental heterozygous variants associated with autosomal recessive diseases were detected in three families, including one with additional fetal diagnostic findings. Diagnostic results or fetal IFs contributed to parental decision-making about termination of the pregnancy in 26 families (26/72 (36.1%)), while negative pES results or identification of VUS encouraged 40 families (40/72 (55.6%)) to continue their pregnancy, which ended in a live birth in all cases.

CONCLUSION

Trio-based pES can provide additional genetic information for pregnancies with fetal ultrasound anomalies without a CNV-seq diagnosis. The incidental findings and parental carrier status reported by trio-based pES with splice-site and mitochondrial genome analysis extend its clinical application, but careful genetic counseling is warranted. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

[Safety of an inactivated 2019-nCoV vaccine (Vero) in adults aged 60 years and older]

Objective: To analyze the safety of an inactivated 2019-nCoV vaccine (Vero cell) in adults aged 60 years and older. Methods: A randomized, double-blind, placebo-controlled clinical study was conducted in May 2020 The eligible residents aged 60 and above were recruited in Renqiu city, Hebei Province. A total of 422 subjects (phase Ⅰ/Ⅱ:72/350) were enrolled. Two doses of the trial vaccine or placebo were randomly administered according to a 0 and 28-day immunization schedule. Subjects were randomly divided into two groups in Phase Ⅰ. Within each group, participants received vaccine or placebo in a ratio of 2∶1. Subjects were randomly divided into four groups in phase Ⅱ to receive low-dose, medium-dose, high-dose vaccine and placebo, respectively, in a ratio of 2∶2∶2∶1. A combination of regular follow-up and active reporting was used to observe adverse reactions within 28 days after vaccination, and compare the incidence rate of adverse reactions in the trial and control groups. Results: 422 subjects were (66.45±4.70) years old, and 48.82% were male (206/422). There were 100, 124, 124 and 74 patients enrolled into the low-dose, medium-dose, high-dose vaccine groups and the placebo group, respectively. One person without the vaccination was removed, and 421 participants who received at least one dose of vaccine were included in the safety analysis. Within 28 days after the first or second dose, a total of 20.67% (87/421) subjects had adverse reactions (both solicitation and non-solicitation). About 76 patients suffered grade 1 adverse reactions [18.05% (76/421)] and 22 patients suffered grade 2 adverse reactions [5.23% (22/421)]. No grade 3 or above adverse reactions occurred. A total of 19.71% (83/421) subjects had solicited adverse reactions. The most common grade 1 adverse reaction was injection site pain, followed by fever and fatigue. The most common grade 2 adverse reactions were fever and fatigue, followed by muscle pain and injection site redness. A total of 2.61% (11/421) subjects had unsolicited adverse reactions. A total of 1.66% (7/421) subjects had serious adverse events after vaccination, and no serious vaccine-related adverse events were reported. Conclusions: The inactivated SARS-CoV-2 vaccine is safe for people aged 60 years and above.

Feasibility of an ultra-low dose contrast media protocol for coronary CT angiography

AIM

To evaluate the feasibility of an ultra-low volume contrast media (CM) protocol for coronary computed tomography angiography (CTA).

MATERIALS AND METHODS

In total, 214 patients receiving coronary CTA were enrolled prospectively and divided into group A (n=107) receiving a conventional dose of CM and group B (n=107) receiving an ultra-low dose. CT values of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) were measured and radiation doses recorded. The image quality was compared between the groups. Changes in renal function indices and proteinuria before, 24, and 72 hours after coronary CTA among those with chronic kidney disease (CKD) were also assessed.

RESULTS

There were significant differences in CT values and radiation doses between groups A and B. In group A, the average RCA, LAD, and LCX CT values were 412.5 ± 79.2, 423.5 ± 73.7, and 422.0 ± 88.1 HU, respectively. In group B, the average RCA, LAD, and LCX CT values were 275.2 ± 16.2, 277.8 ± 16.4, and 278.9 ± 16.5 HU, respectively. The radiation dose in the ultra-low protocol recipients (118.70 ± 18.52 mGy·cm) was significantly lower than that used in conventional coronary CTA (131.75 ± 20.96 mGy·cm). The image quality of group B was comparable to that of group A, satisfying the diagnostic requirement. In patients with mild CKD, there were no significant differences in renal functions after coronary CTA.

CONCLUSION

An ultra-low CM protocol was established for coronary CTA, providing comparable image quality and diagnostic yields but significantly lower radiation dose compared with a conventional protocol. This new protocol might be applicable to patients with mild CKD.

A novel multi-objective optimization framework for urban green-gray infrastructure implementation under impacts of climate change

Frequent urban flooding disasters can cause severe economic and property losses. Accordingly, the construction of sponge city has become critical to alleviating urban flooding. However, the functional and structural integration of Green Infrastructure (GI) and Gray Drainage Facility (GDF) is still a matter of concern. This study proposed a novel implementation framework for GI and GDF synchronization optimization (G-GSOIF) based on the SWMM and SUSTAIN models, and used data from Beilin District in Xi'an, China to verify the effects. The results show that the spatiotemporal integrated optimization design of GI and GDF proves to be effective in stormwater management. The total investment was reduced by 16.7% and economic benefit was increased by 15.4% based on disaster risk control, and the utilization rate of rainwater resources exceeded 40%. The Staged optimization model (SSOM) based on the SUSTAIN model established in the G-GSOIF was demonstrated to effectively cope with the impact of future climate change by adjusting and optimizing the design scheme dynamically in different simulation scenarios. Integrated LID (I-LID) measures are conducive for simulation of large catchment areas, and have the same implementation effect as distributed LID measures. The results of this study could support decision-making for urban stormwater management and sponge city construction.

Exerimental method and preliminary studies of the passive containment water film evaporation mass transfer

For larger containments and higher operation parameters, characteristics of the outside cooling of the PCCS are very important for the analysis on the containment integrity. A preliminary analysis was made and a four-step experimental method was used to numerically analyze the falling water film evaporation for the advanced passive containment. Then, the water flow stability along the outside wall of the containment was studied. The results fit well with those correlations without airflow when the air velocity is less than 5.0 m/s. However, when the air velocity is larger than 5.0 m/s, the influence of the air velocity on the water film will appear and the mean water film thickness will be thicker. Based on the prototype operation parameters, experimental studies were carried and the results were compared with the Dittus-Boelter correlation within the operation ranges. A modification factor was proposed for the conservative application of this correlation for nuclear safety analysis.

Lnc-AC145676.2.1-6-3 can influence STX3-induced abnormal autophagy by sponging hsa-miR-1292-3p in intestinal aGVHD

OBJECTIVE

Intestinal acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Abnormal autophagy levels in intestinal aGVHD have been confirmed in many studies. LncRNAs exert coregulatory functions and participate in a variety of intracellular regulatory processes. In this study, we investigated how lnc-AC145676.2.1-6-3 regulates dysregulated STX3-related autophagy in aGVHD.

MATERIALS AND METHODS

First, we established a mouse model of aGVHD by transplanting a mononuclear cell suspension from Balb/c donor mice treated with 60Co X-rays into CB6F1 recipient mice. STX3-related indicators were analyzed by Western blotting (WB) and immunohistochemistry which confirmed that STX3 plays an important role in dysregulating autophagy in intestinal aGVHD. TNF-αinduced Caco-2 cells, which is an in vitro model of intestinal barrier dysfunction, were established to verify the effect of STX3. The direct interaction between the partners of lnc-AC145676.2.1-6-3-mediated hsa-miR-1292-3p and STX3 axis was evaluated by the Dual-Luciferase activity assay. We performed PCR, WB, and immunofluorescence in Caco-2 cells to determine whether the abnormal autophagy levels were influenced by lnc-AC145676.2.1-6-3.

RESULTS

The results showed that lnc-AC145676.2.1-6-3 could significantly suppress the number of autophagic vacuoles, the LC3-II/I ratio, and beclin1 levels by increasing STX3 levels.

CONCLUSIONS

Lnc-AC145676.2.1-6-3 may play an important role in intestinal aGVHD by targeting STX3.

An application research for near-surface repository of strontium-90 sorption kinetic model on mudrocks

In this study,90Sr was used as the test radionuclide to characterize the sorption kinetics and effects of initial 90Sr activity and remaining 90Sr in solid concentration were simulated for a near-surface repository. The study focused on the sorption characteristics of radionuclides in unsaturated groundwater environment (or vadose zone) is the important information for investigating the near-surface disposal of intermediate and low-level radioactive waste (ILLW). Moreover, the 90Sr sorption experiments reached equilibrium within 56 h, which fit to the first order sorption kinetic model, and the remaining 90Sr in mudrock samples showed obvious sorption equilibrium hysteresis, which fit to the second order sorption kinetic model. Before reaching the maximum sorption capacity, the sorption rate constant increases with 90Sr increasing; the distribution coefficient (Kd) of 56 h decreases with the remaining 90Sr decreasing. In addition, it showed that the slow sorption process dominated before the sorption reaches equilibrium. In fact, a reliable safety assessment methodology for on-going near-surface repository required a lot of the radionuclides parameters with local environment including the radionuclides sorption/desorption rate constant and maximum sorption capacity.

A Nonlinear Optimal Control Approach for Multi-DOF Brachiation Robots

This paper proposes a nonlinear optimal control approach for mulitple degrees of freedom (DOF) brachiation robots, which are often used in inspection and maintenance tasks of the electric power grid. Because of the nonlinear and multivariable structure of the related state-space model, as well as because of underactuation, the control problem of these robots is nontrivial. The dynamic model of the brachiation robots undergoes first approximate linearization with the use of Taylor series expansion around a temporary operating point which is recomputed at each iteration of the control method. For the approximately linearized model, an H-infinity feedback controller is designed. The linearization procedure relies on the Jacobian matrices of the brachiation robots’ state-space model. The proposed control method stands for the solution of the optimal control problem for the nonlinear and multivariable dynamics of the brachiation robots, under model uncertainties and external perturbations. For the computation of the controller’s feedback gains an algebraic Riccati equation is solved at each time-step of the control method. The global stability properties of the control scheme are proven through Lyapunov analysis. The new nonlinear optimal control approach achieves fast and accurate tracking for all state variables of the brachiation robots, under moderate variations of the control inputs.

Value of low-dose spiral CT combined with circulating miR-200b and miR-200c examinations for lung cancer screening in physical examination population

OBJECTIVE

  The aim of this study is to investigate the clinical value of low-dose spiral CT (LDCT), plasma miR-200b, and miR-200c combined screening for lung cancer screening in the physical examination population.

PATIENTS AND METHODS

From January 2016 to December 2018, the Physical Examination Center of our hospital underwent low-dose spiral CT lung cancer screening for 10,823 people aged ≥40 years. The quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the relative expressions of miR-200b and miR-200c in plasma, analyze the imaging characteristics of suspicious nodules in the lung and the relative expressions of miR-200b and miR-200c in plasma.

RESULTS

A total of 2,919 pulmonary nodules were detected in the 10823 physical examination population, with a total detection rate of 26.97%, including 1523 males and 1396 females. 1081 positive nodules were detected with a detection rate of 9.99%. According to the Lung-RADS classification, the number of type 2 nodules was the highest, with a detection rate of 22.13%. Meanwhile, the rate of type 3 nodules was 3.15%, and the rate of type 4 nodules was 1.69%. The sensitivity, accuracy, and negative predictive value of LDCT, miR-200b, and miR-200c in the diagnosis of lung cancer were significantly improved compared with the individual tests, which were 94.74%, 90.16%, and 95.88%, respectively.

CONCLUSIONS

Low-dose spiral CT combined with plasma miR-200b and miR-200c for lung cancer screening in the physical examination population can help to detect lung cancer patients with early symptoms that are not significant, and achieve early diagnosis and early treatment.

Degree of peripheral Thyroxin Deiodination and recurrent cardiovascular events in euthyroid patients undergoing PCI: five-year findings from a large single-center cohort study

Background

In euthyroid patients undergoing percutaneous coronary intervention (PCI), it is still unclear whether thyroxin deiodination level can predict the recurrence of cardiovascular events (CVEs). Using free triiodothyronine to free thyroxine (FT3/FT4) ratio, a marker of peripheral thyroxin deiodination, we aim to investigate its association with recurrent long-term adverse events in this population.

Methods

3549 euthyroid patients with prior CVEs history undergoing PCI were consecutively enrolled in our study and subsequently divided into three FT3/FT4 ratio tertiles (T1&lt;2.41, n=1170; 2.41≤T2&lt;2.75, n=1198; T3&gt;2.75, n=1181). The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), a composite of all-cause death, myocardial infarction, stroke and revascularization. The secondary endpoints were all-cause death and cardiac death.

Results

The median follow-up time was 5 years. The incidence of all-cause death, cardiac death and MACCE were significantly higher among patients in the lowest FT3/FT4 tertile (P&lt;0.05). After adjustment of confounding factors, decreased FT3/FT4 ratio was independently associated with an increased risk of all-cause death (HR 1.82, 95% CI 1.13–2.93, P=0.014), cardiac death (HR 1.90, 95% CI 1.04–3.46, P=0.036) and MACCE (HR 1.33, 95% CI 1.10–1.60, P=0.003).

Conclusions

In euthyroid patients undergoing PCI, FT3/FT4 ratio, a surrogate marker of peripheral thyroxin deiodination, demonstrates a strong association with long-term recurrent cardiovascular events. Routine assessment of FT3/FT4 ratio might be a simple and effective tool for risk stratification in this specific patient population.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China (No. 2016YFC1301300, 2016YFC1301301); National Natural Science Foundation of China (No. 81770365)

Prognostic utility of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: five-year findings from a large single-center cohort

Background

The prognosis for patients with coronary artery disease (CAD) remains unfavorable despite advances in treatment. Fibrinogen (FIB) is an independent risk factor for mortality and cardiovascular events in general population. However, the relationship between FIB and long-term mortality among CAD patients undergoing PCI is less investigated, especially in individuals concomitated with diabetes mellitus (DM) and prediabetes (Pre-DM).

Methods

6140 patients with CAD undergoing PCI were consecutively enrolled in our study and subsequently divided into three groups according to FIB levels (FIB-L, FIB-M, FIB-H). These patients were further grouped by glycemic metabolism state [normoglycemia (NG), Pre-DM, DM]. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality.

Results

FIB was positively associated with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) both in CAD patients with and without DM. During a median follow-up time of 5.1 years, elevated FIB was significantly associated with long-term mortality from all-cause (adjusted HR: 1.86; 95% CI: 1.28–2.69; P=0.001) and cardiac specific (adjusted HR: 1.82; 95% CI: 1.15–2.89; P=0.011). Similarly, patients with DM but not Pre-DM had increased risk of all-cause and cardiac mortality (all P&lt;0.05). When grouped by both FIB levels and glycemic metabolism state, diabetic patients with medium and high FIB levels had higher risk of mortality [(adjusted HR: 2.57; 95% CI: 1.12–5.89), (adjusted HR: 3.04; 95% CI: 1.35–6.82), all P&lt;0.05]. Notably, prediabetic patients with high FIB also had higher mortality risk (adjusted HR: 2.27; 95% CI: 1.01–5.12).

Conclusion

FIB was strongly associated with long-term all-cause and cardiac mortality among CAD patients undergoing PCI, especially in persons concomitated with DM and Pre-DM, indicating FIB test may help identify high-risk individuals in this specific patient population.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China (No. 2016YFC1301300, 2016YFC1301301); National Natural Science Foundation of China (No. 81770365)

High urinary excretion rate of glucose attenuates serum uric acid level in type 2 diabetes with normal renal function

AIMS/INTRODUCTION

The relationship between urinary excretion rate of glucose (UEGL) and uric acid (UA) metabolism in adults with type 2 diabetes (T2D) remains unclear to date. This study aimed to investigate the relationships of UEGL with serum UA (SUA), urinary excretion rate of uric acid (UEUA), and renal clearance of uric acid (CLUA) in adults with T2D. We hypothesised that high UEGL increases UA excretion, which in turn leads to lower SUA.

MATERIALS AND METHODS

This was a cross-sectional study of 635 inpatients with T2D recruited between 2018 and 2019. The relationships of UEGL with UEUA, CLUA, and hyperuricaemia were assessed using analysis of covariance and multivariate regression analysis.

RESULTS

Patients in the higher quartile of UEGL tended to have lower SUA levels than those in the lower quartile. In contrast, patients in the higher quartile of UEGL tended to have higher CLUA (p for trend < 0.0001), and a similar trend was observed for UEUA. In adjusted multivariable linear regression model, UEGL was negatively correlated with SUA (β = - 0.023, 95% CI - 0.034 to - 0.013, p < 0.0001). However, positive correlations of UEGL with UEUA (β = 0.046, 95% CI 0.018-0.074, p = 0.001) and CLUA (β = 0.063, 95% CI 0.042-0.085, p < 0.0001) were found. Furthermore, consistent significant inverse associations were observed between quartiles of UEGL and hyperuricaemia in the adjusted multivariate logistic regression model.

CONCLUSIONS

A high UEGL level was positively correlated with UEUA and CLUA. Moreover, it was inversely associated with SUA level, and a consistently increased UEGL level reduced the risk of hyperuricaemia in patients with T2D.

Risk factors for incomplete thrombosis in false lumen in sub-acute type B aortic dissection post-TEVAR

There is scarce information about the risk factors for incomplete false lumen thrombosis (FLT) among type B aortic dissection (AD) patients, particularly in the sub-acute phase following thoracic endovascular aortic repair (TEVAR). We enrolled consecutive sub-acute type B AD patients at Xinqiao Hospital (Chongqing, China) from May 2010 to December 2019. Patients with severe heart failure, cancer, and myocardial infarction were excluded. The postoperative computed tomography angiography (CTA) data were extracted from the most recent follow-up aortic CTA. Multivariate logistic regressions were applied to identify the association between FLT and clinical or imaging factors. Fifty-five subjects were enrolled in our study. Twelve participants showed complete FLT, and 2 of these died during the follow-up, while 8 patients died in incomplete FLT group. In the multivariate analysis, maximum abdominal aorta diameter (OR 1.20, 95% CI 1.016-1.417 p = 0.032) and the number of branches arising from the false lumen (FL) (OR 15.062, 95% 1.681-134.982 p = 0.015) were significantly associated with incomplete FLT. The C-statistics was 0.873 (95% CI 0.773-0.972) for the model. The FL diameter (p < 0.001) was significantly shorter following TEVAR, while the true lumen diameter (p < 0.001) and maximum abdominal aorta diameter (p = 0.011) were larger after the aortic repair. There were 21.8% of sub-acute type B AD patients presented complete FLT post-TEVAR. Maximum abdominal aorta diameter and the number of branches arising from the FL were independent risk factors for incomplete FLT. The true lumen diameter, maximum abdominal aorta diameter, and FL diameter changed notably following TEVAR.

Clinical efficacy of mouse nerve growth factor plus nimodipine in neonatal intracranial hemorrhage and its effect on plasma PAF, CNP, MMP-2, and neurological function

OBJECTIVE

To investigate the clinical efficacy of combination of mouse nerve growth factor (NGF) and nimodipine in the treatment of neonatal intracranial hemorrhage (NICH) and its effect on plasma platelet-activating factor (PAF), C-type natriuretic peptide (CNP), matrix metalloproteinase-2 (MMP-2), and neurological function.

PATIENTS AND METHODS

A total of 90 infants with severe ICH admitted to our hospital from December 2016 to December 2018 were enrolled for retrospective study. According to different treatment schemes, they were assigned into 2 groups: group A (n=40) treated with mouse NGF plus nimodipine; group B (n=50) treated with nimodipine. The recovery time, serum indexes (PAF, MMP-2, CNP), neurological function (neonatal behavioral neurological assessment (NBNA) score), complications, and total effective rate of patients were recorded, and the satisfaction degree of family members was statistically analyzed.

RESULTS

Patients in group A showed shorter recovery time, down-regulated PAF and MMP-2, evidently up-regulated CNP, and significantly increased NBNA score after one/two weeks of treatment, as well as fewer complications, higher total effective rate and higher satisfaction of family members.

CONCLUSIONS

To sum up, the combination of mouse NGF and nimodipine achieves good clinical efficacy in NICH, which down-regulates plasma PAF and MMP-2, up-regulates CNP, and improves neurological function. Therefore, it is suitable for clinical promotion.

MiR-127-3p inhibits proliferation of ovarian cancer in rats through down-regulating MAPK4

OBJECTIVE

To reveal the anti-tumor effect of micro ribonucleic acid (miR)-127-3p on epithelial ovarian cancer (EOC).

PATIENTS AND METHODS

The expression of miR-127-3p in 7 kinds of EOC cell lines and 10 cases of clinical samples of EOC patients was detected via quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR). OVCAR-3 and Caov-3 cell lines were transfected with lentiviruses to overexpress endogenous miR-127-3p. Then, the anti-tumor effect of miR-127-3p on EOC cells was explored through the in vitro cell proliferation assay, bufalin sensitivity assay, wound healing assay, and invasion assay. In addition, whether the mitogen-activated protein kinase 4 (MAPK4) gene is a downstream target of miR-127-3p in EOC was verified via Dual-Luciferase reporter assay and qRT-PCR. The involvement of MAPK4 in regulating phenotypes of OVCAR-3 and Caov-3 cells was finally explored.

RESULTS

MiR-127-3p was downregulated in both EOC cell lines and EOC tissues (p<0.05). After lentivirus-mediated overexpression of miR-127-3p, in vitro proliferation and invasion of EOC cells were inhibited, and the sensitivity to bufalin was enhanced (p<0.05). MiR-127-3p directly regulated MAPK4 gene in EOC. Moreover, the upregulation of MAPK4 inhibited the anti-tumor effect of miR-127-3p on EOC, manifested as the remarkably enhanced cell proliferation and migration (p<0.05), and the weakened sensitivity to bufalin (p<0.01).

CONCLUSIONS

MiR-127-3p exerts an inhibitory effect on EOC cells via regulating MAPK4 level.

Prognostic Significance of B-Type Natriuretic Peptide in Patients With Left Ventricular Thrombus

Background and Aims: There is sparse information on the prognostic value of B-type natriuretic peptide (BNP) for the outcomes in patients with left ventricular thrombus (LVT).

Methods: Patients diagnosed with LVT by transthoracic echocardiography between November 2009 to July 2020 at our institution were included. The endpoints were all-cause mortality and systemic embolism.

Results: Ninety-two subjects were finally included in the study. The mean age of the cohort was 56.73 ± 14.12, and 80.4% of the patients were male. The median BNP (1st quartile−3rd quartile) was 437.5 (112.74–1317.5). The total all-cause mortality rate was 30.44% (28/92), and the 1-year, 2-year, and 3-year cumulative survival rates were 85.4, 75.5, and 66.5%, respectively. Systemic embolism was identified in 10 subjects. COX multivariate analysis showed that Log BNP (HR, 4.16; 95%CI, 1.81–9.56; P = 0.001) and BMI (HR, 0.86; 95%CI, 0.73–0.99; P = 0.048) were significantly associated with all-cause mortality. In addition, patients with BNP levels in the upper median (≥ 437.5 pg/ml) had significantly higher all-cause mortality rate compared to those with lower median BNP (<437.5 pg/ml; P = 0.004). The area under the receiver operating characteristic curve for BNP and all-cause mortality was 0.71. In the linear trend test, BNP quartiles were significantly related to all-cause mortality in all models, and the P-values for trend in models 1, 2, and 3 were 0.005, 0.006, and 0.048, respectively.

Conclusion: BNP level is a prognostic factor for all-cause mortality in LVT patients, and elevated BNP is indicative of a higher risk of LVT.

Nurses' experiences in response to COVID-19 in a psychiatric ward in Singapore

Aim

To understand nurses’ responses to COVID‐19 and identify their uptake of changes in the procedure required for the management of COVID‐19 in an inpatient psychiatric ward.

Background

The infection risk for COVID‐19 in an enclosed inpatient psychiatric ward is high due to living arrangements in the ward and the nature of the infectious disease.

Introduction

This paper describes inpatient nurses’ experiences, challenges and strategies deployed at the institutional and national levels to contain the spread of infection.

Methods

Written feedback was collected to understand nurses’ responses and identify their uptake of changes in procedure following the COVID‐19 outbreak in the ward.

Findings

Nurses felt shocked, worried, isolated, expressed a lack of confidence, and experienced physical exhaustion. COVID‐19 specific challenges were highlighted in the delivery of safe and quality nursing care. Nurses were satisfied with the hospital policy and strategies implemented during the outbreak, acknowledging the importance of support from nursing leaders.

Discussion

Practical support and strong nursing leadership have been imperative in the battle against the COVID‐19 outbreak in the psychiatric hospital. Psychiatric nursing care was maintained with a modified management and treatment approach.

Implications for Nursing practice

Nurses' willingness to adjust to the reconfiguration of operations to accommodate changes has been crucial for the healthcare system to run effectively. Good practices and policies established during this crisis should be developed and established permanently in nursing practice.

Implications for Health Policy

Prompt and effective contingency planning and policymaking at the national and institutional level, targeting human resource management and infection control, can introduce changes and alternative options for nursing care in a pandemic.

Conclusion

With support from influential nursing leaders, strategies and policies are imperative in ensuring the successful management of COVID situations in an inpatient psychiatric setting.

A196 MORE MICROSCOPIC THAN WAS THOUGHT: A RARE CASE OF ISOLATED LYMPHOCYTIC ILEITIS WITHOUT MICROSCOPIC COLITIS

Background

Microscopic colitis (MC) is a chronic inflammatory disease of the colon characterized by lymphocytic infiltration with (collagenous colitis) or without (lymphocytic colitis) the expansion of collagen fibres, and the normal macroscopic appearance of the mucosa on ileocolonoscopy. Recent studies have shown that the ileum may be involved in MC, occurring concurrently with colonic disease, however there is sparse literature on isolated lymphocytic ileitis without colitis.

Aims

We describe the case of isolated small bowel lymphocytosis without evidence of lymphocytic colitis to highlight the utility of random biopsies of the terminal ileum in cases where microscopic colitis is a diagnostic consideration.

Methods

A 70-year-old female known for cutaneous mastocytosis presented with six weeks of abdominal pain, non-bloody diarrhea, intolerance to oral intake and significant weight loss. Computed-tomography showed evidence of possible mesenteric panniculitis. Colonoscopy revealed a normal colon and normal-appearing mucosa of the terminal ileum. Random mucosal biopsies were taken to assess for microscopic colitis, with terminal ileal biopsies revealing significant lymphocytic infiltration consistent with lymphocytic ileitis. Biopsies throughout the colon revealed normal colonic mucosa without evidence of concurrent microscopic colitis. Gastroscopy was macroscopically unremarkable and random biopsies in the stomach and duodenum were negative for Helicobacter pylori and lymphocytosis. Immunostaining of the gastric, duodenal, terminal ileal and colonic biopsy specimens were negative for CD25, CD117 and tryptase, indicating the absence of gastrointestinal mastocytosis.

Results

The patient was diagnosed with lymphocytic ileitis and given the known response of MC to budesonide, she was treated with eight weeks of budesonide with clinical improvement leading to remission of her symptoms.

Conclusions

This case illustrates a rare incidence of isolated ileal microscopic ileitis without colitis that responded well to standard MC treatment, thereby underscoring the utility of random biopsies in the terminal ileum and throughout the colon when microscopic colitis is on the differential diagnosis.

Funding Agencies

None

Incidence, Risk Factors, and Outcomes of Coronary Obstruction Following Valve-in-Valve Transcatheter Aortic Valve Replacement

There is scant information about the incidence, risk factors, and outcomes of coronary obstruction (CO) following valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). A meta-analysis of the published studies from January 2000 to April 2020 was conducted, and the endpoint was CO. A total of 2858 patients were enrolled in this study. The mean age was 77.7 ± 9.8, and 39.9% of them were female. The Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EuroSCORE), and Logistic EuroSCORE were 8.9 ± 7.8, 16.0 ± 10.9, and 26.3 ± 16.3, respectively. The overall incidence of CO was 2.58%. CO incidence between patients with prior stented and stentless valves were significantly different (1.67% versus 7.17%), with an odds ratio (OR) of 0.25 and a 95% confidence interval (CI) of 0.14-0.44 (P < 0.00001). The first-generation valves were significantly associated with higher CO incidence compared with the second-generation valves (7.09% versus 2.03%; OR, 2.44; 95%CI, 1.06-5.62; P = 0.04), while no statistical difference was found between self-expandable valves and balloon-expandable valves (2.45% versus 2.60%; OR, 0.99; 95%CI, 0.55-1.79; P = 0.98). Virtual transcatheter to coronary ostia (VTC) distance (3.3 ± 2.1 mm, n = 29 versus 5.8 ± 2.4 mm, n = 169; mean difference, -2.70; 95%CI, -3.46 to -1.95; P < 0.00001) and the sinus of Valsalva (SOV) diameter (27.5 ± 3.8 mm, n = 23 versus 32.3 ± 4.0 mm, n = 101; mean difference, -3.80; 95%CI, -6.55 to -1.05; P = 0.007) were enormously shorter in patients with CO. The 24-hour, in-hospital, and 30-day mortality of patients with CO were 10.5%, 30.8%, and 37.1%, respectively. In conclusion, device selections, VTC distances, and SOV diameters may be important factors in assessing the CO risk in VIV-TAVR.

Isomer yields in nuclear fission

The generation of angular momentum in the fission process is still an open question. To shed light on this topic, we started a series of measurements at the IGISOL-JYFLTRAP facility in Finland. Highprecision measurements of isomeric yield ratios (IYR) are performed with a Penning trap, partly with the aim to extract average root-mean-square (rms) quantities of fragment spin distributions. The newly installed Phase-Imaging Ion-Cyclotron Resonance (PI-ICR) technique allows the separation of masses down to tens of keV, which is suffcient to disentangle many isomers. In this paper, we first summarize the previous measurements on the neutron and proton-induced fission of uranium and thorium, e.g. the odd cadmium and indium isotopes (119 ≤ A ≤ 127). The measurements revealed systematic trends as function of mass number, which stimulated further exploration. A recent measurement was performed at IGISIOL and several new IYR data will soon be published, for the first time. Secondly, we employ the TALYS nuclear-reaction code to model one of the newly measured isomer yields. Detailed GEF and TALYS calculations are discussed for the fragment angular momentum distribution in 134I.

Prognostic Value of Preoperative Hemoglobin Levels for Long-Term Outcomes of Acute Type B Aortic Dissection Post-thoracic Endovascular Aortic Repair

Background and Aims: There is scant information available about the prognostic value of preoperative hemoglobin (Hb) levels on the long-term outcomes of acute type B aortic dissection (ABAD) following thoracic endovascular aortic repair (TEVAR).

Methods: A retrospective analysis of consecutive patients from 2010 to 2018 regarding the relationship between Hb level and long-term outcomes was conducted. The primary endpoint was all-cause mortality. Major adverse cardiovascular events (MACEs) included all-cause death, recurrent ruptures, and secondary procedures.

Results: In total, 391 subjects treated by TEVAR were enrolled, with a mean age of 57.1 ± 12.0 years; 79.5% of them were male. Cox multivariate analysis showed that the preoperative Hb level was independently associated with all-cause death [adjusted hazard ratio (HR) 0.797 (per 1 g/dl), 95% confidence interval (CI) 0.693–0.918, p = 0.002] and MACEs (adjusted HR 0.795, 95% CI 0.672–0.871, p = 0.000). The area under the receiver operating characteristic curve of Hb for all-cause death and MACEs were 0.617 (95% CI 0.548–0.687, p = 0.008) and 0.617 (95% CI 0.551–0.684, p = 0.005), respectively. In the linear trend test, Hb concentration was significantly related to all-cause mortality (p for trend = 0.001) and MACEs (p for trend = 0.000). Moreover, in Kaplan–Meier analysis, lower Hb levels (< 12 g/dl) were significantly different from higher Hb (≥12 g/dl) levels for both all-cause death (log-rank p = 0.001) and MACEs (log-rank p = 0.001). Similar results were found when assessing the prognostic value of red blood cell count and anemia.

Conclusions: Preoperative Hb may serve as a prognostic marker for long-range adverse outcomes for ABAD patients post-TEVAR.

[The effect of booster dose vaccination 21- to 32-years after primary vaccination with hepatitis B vaccine in the population born from 1986 to 1996 in Zhengding County of Hebei Province]

Objective: Aanalysis the effect of booster one dose of hepatitis B vaccine after 21-32 years of primary immunization in Zhengding Country of Hebei Province. Methods: A total of 322 participants who were born between 1986 and 1996, received a full course of primary vaccination with plasma-derived hepatitis B vaccine (HepB), had no experience with booster vaccination, were HBsAg, anti-HBcnegative, had anti-HBs<10 mIU/ml, completed the booster and had laboratory results were enrolled between August 2017 to February 2018. A simple random method was uesd to randomly assigned 322 subjects to two groups, receiving a booster dose of HepB derived from either Saccharomyces cerevisiae ［HepB (SC), (151 cases)］ or Chinese hamster ovary-derived HepB ［HepB (CHO), (171 cases)］, the dose was 20 μg. Blood samples were collected 30 days after boosting and quantitatively tested for the geometric mean concentration (GMC) of anti-HBs to assess immunological effect. The related influencing factors of GMC and seroconversion rates of anti-HBs were analyzed by multiple linear regression and multivariate logistic regression models. Results: The 266 subjects (82.61%) had anti-HBs≥ 10 mIU/ml, and GMC was (131.63±12.94) mIU/ml.The seroconversion rates of anti-HBs in the anti-HBs<2.5 mIU/ml group and 2.5-10 mIU/ml group were 74.54% (161 cases) and 99.06% (105 cases), respectively (P<0.001).The seroconversion rates of anti-HBs after one dose of HepB (CHO) was higher than that of one dose of HepB (SC), the seroconversion rates were 87.13% (149 cases) and 77.48% (117 cases), respectively (P=0.023). Participants boostered with HepB (CHO) was the factor influencing the effect of strengthening immunization compared with boostered with HepB (SC), and OR (95%CI) was 1.91 (1.02-3.56) (P=0.042).Compared with anti-HBs<2.5 mIU/ml, prebooster anti-HBs was between 2.5 mIU/ml and 10 mIU/ml was the related factor of seroconversion rates of anti-HBs after booster immunization, and OR (95%CI) was 36.15 (4.91-266.02) (P<0.001). Conclusion: Participants boostered withone dose of HepB had a good immune response. Pre-booster anti-HBs concentration and a variety of vaccine were related factors of immune response.