Melatonin regulates the circadian rhythm to ameliorate postoperative sleep disorder and neurobehavioral abnormalities in aged mice

BACKGROUND

Postoperative sleep disorder (PSD) and delirium, which may be associated with surgery and inhalational anesthetics, induce adverse effects in old adults. Emerging evidence indicates that circadian rhythm contributes to various neuropathological diseases, including Alzheimer's disease. Thus, we analyzed the potential role of circadian rhythm in PSD and delirium-like behavior in aged mice and determined whether exogenous melatonin could facilitate entrainment of the circadian rhythm after laparotomy under sevoflurane anesthesia.

METHODS

We selected old C57BL/6J mice which receiving laparotomy/sevoflurane anesthesia as model animals. We employed buried food, open field, and Y maze test to assess delirium-like behavior, and electroencephalography/electromyography (EEG/EMG) were used to investigate sleep changes. We analyzed the transcription rhythm of clock genes in superchiasmatic nucleus (SCN) to explore the effects of surgery and melatonin pretreatment on the circadian rhythm. Then, we measured melatonin receptor levels in SCN and ERK/CREB pathway-related proteins in hippocampus and prefrontal cortex to assess their role in PSDs and delirium-like behavior.

RESULTS

Laparotomy under sevoflurane anesthesia had a greater influence than sevoflurane alone, leading to sleep disorder, a shift in sleep-wake rhythm, and delirium-like behavior. Bmal1, Clock, and Cry1 mRNA expression showed a peak shift, MT1 melatonin receptor expression level was increased in the SCN, and p-ERK/ERK and p-CREB/CREB were decreased in hippocampus and prefrontal cortex of aged mice 1 day after laparotomy. Melatonin showed significant efficacy in ameliorating PSD and delirium-like behavior and restoring the circadian rhythm, reversing melatonin receptor and ERK/CREB pathway expression abnormalities. In addition, most of the beneficial effect of melatonin was antagonized by luzindole, a melatonin receptor antagonist.

CONCLUSIONS

Melatonin receptors in SCN, circadian rhythm, and ERK/CREB signaling pathway participate in the pathophysiological processes of PSD and delirium-like behavior. Melatonin intervention could be a potential preventative approach for PSD and delirium.

[Study of the predictive role of serum HBV RNA on HBeAg serological conversion in children with chronic hepatitis B]

Objective: To investigate the role of serum hepatitis B virus RNA (HBV RNA) in predicting HBeAg serological conversion in children with chronic hepatitis B. Methods: 175 children aged 1~17 years with chronic hepatitis B who received interferon α (IFNα) for 48 weeks were selected. Patients were divided into HBeAg seroconversion and non-conversion based on whether HBeAg seroconversion occurred at 48 weeks of treatment.T-test and Mann-Whitney U test were used to compare between groups; chisquare test or Fisher exact probability method was used to compare the frequency between groups of classified variables; and Pearson correlation was used to analyze the correlation between indicators. Univariate and multivariate logistic regression analyses were used to identify influencing factors associated with HBeAg serological conversion. The predictive effect of HBV RNA, HBV DNA, and HBsAg on HBeAg serological conversion was compared and analyzed by the receiver operating characteristic curve (ROC). Results: The seroconversion rate of HBeAg at 48 weeks was 36.0% (63/175). The reduction in HBVRNA levels from baseline to the 12th, 24th, 36th, and 48th weeks of antiviral therapy was significantly greater in the HBeAg serological conversion group than that in the non-conversion group, and the difference was statistically significant between the two groups (P < 0.05). Univariate and multivariate regression analyses showed that age and a decline in HBV RNA levels at week 12 were independent predictors of HBeAg serological conversion. The area under the ROC curve (AUROC) of HBV RNA decline at week 12 was 0.677(95% CI∶0.549-0.806, P = 0.012), which was significantly better than the same period of AUROC of HBV DNA (0.657, 95% CI∶0.527-0.788, P = 0.025) and HBsAg (0.660, 95% CI∶0.526-0.795, P = 0.023) decline. HBV RNA levels decreased (>1.385 log10 copies/ml) at week 12, with a positive predictive value of 53.2%, a negative predictive value of 72.2%, a sensitivity of 77.4%, and a specificity of 57.9% for HBeAg seroconversion. Conclusion: HBV RNA level lowering during the 12th week of antiviral therapy can serve as an early predictor marker for HBeAg serological conversion in children with chronic hepatitis B.

Enhancement Patterns of Metastatic Intrahepatic Cholangiocarcinoma and Outcomes after Chemotherapy and Radiation

PURPOSE/OBJECTIVE(S)

Patients with metastatic intrahepatic cholangiocarcinoma (M1-iCCA) have a poor prognosis with a 5-year survival rate of less than 20%. Definitive doses of radiation therapy (RT) after upfront chemotherapy (chemo/RT) in this patient population have shown to prolong survival by reducing the risk of tumor-related liver failure compared to chemotherapy alone. Our group has also identified a baseline radiographic feature, the arterial enhancement pattern, which has pathological and prognostic associations for iCCA. We tested the hypothesis that baseline arterial enhancement is independently associated with survival outcomes for patients who receive chemo/RT or chemo alone.

MATERIALS/METHODS

Patients with M1-iCCA from 2010 to 2021 were included in this retrospective study. Patients were grouped into those who underwent chemo alone and those who underwent chemo/RT. The inclusion criteria included confirmed diagnosis of M1-iCCA, availability of baseline multi-phasic computed tomography (CT), and follow-up for at least six months or until death. Tumor arterial enhancement patterns were categorized as previously described into hypovascular or hypervascular, where the tumors that were hypervascular had either peripheral enhancement or central enhancement. Mean tumor density in Hounsfield units was recorded for each patient. Survival was estimated using the Kaplan Meier method, and Cox proportional models were used to adjust for prognostic variables.

RESULTS

A total of 281 patients with iCCA were identified and 229 had evaluable CT scans. Demographic and baseline characteristics of patient groups are shown in the Table. On univariate analysis, patient age, ECOG performance status (PS) at diagnosis, treatment type, and arterial enhancement patterns associated with overall survival (OS). On multivariable analysis, the arterial enhancement pattern independently associated with OS after accounting for covariates. Patients with hypervascular tumors had prolonged OS compared to those with hypovascular tumors (HR = 0.72, [0.54 - 0.96], p = 0.02). Prolonged OS was also observed in the chemo/RT group compared to the chemo alone group (HR = 0.37, [0.25-0.54], p< 0.0001).

CONCLUSION

Baseline enhancement patterns of M1-iCCA were prognostic in the contexts of chemo alone and chemo/RT. This imaging-based biomarker may improve the ability to stratify patients for therapeutic management.

Development of a Brief Cognitive Screening Tool for Predicting Postoperative Delirium in Patients with Parkinson's Disease: A Secondary Analysis

Background

A simple, rapid, and effective cognitive screening test appropriate for fast-paced settings with limited resources and staff is essential, especially preoperatively. This study aimed to develop and validate the short versions of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for predicting postoperative delirium (POD) in patients with Parkinson's disease (PD) who were scheduled for surgery.

Methods

The current study was a secondary analysis of data collected from 128 inpatients scheduled for deep brain stimulation of the subthalamic nuclei (STN-DBS) lasting >60 min, at Tsinghua University Yuquan Hospital, China. Preoperative cognitive screening was performed during the preoperative visit using the MMSE and MoCA. The optimal MMSE and MoCA cut-off scores for detecting PD-MCI was 27 and 23 respectively. The POD was assessed twice a day on the first postoperative day until discharge by the confusion assessment method. The backward conditional logistic regression analysis was used to organize the reduced versions of the MMSE or MoCA. Also, the areas under the receiver operating characteristic curves (AUCs) were examined using the DeLong test.

Results

125/128 PD patients were included in the analysis, and 27 (21.6%) developed POD. The MMSE reduced version (orientation to time, attention and calculation, and comprehension) demonstrated performance similar to the original MMSE in predicting POD (z=0.820, p=0.412). The AUC of the original MoCA and the short MoCA (visuospatial and executive attention and orientation) were 0.808 and 0.826, respectively. There was no significantly difference in the AUC values between the tests (z=0.561, p=0.575).

Conclusion

Our simplified MMSE and MoCA could be efficiently used to identify patients at risk for POD. Also, short cognitive tests could be considered while predicting POD in fast-paced preoperative settings with limited resources and staff.

Compensating for gyroradius effects in beamlines with small Helmholtz coils

Measurements of lighter, low-energy charged particles in a laboratory beamline are complicated due to the influence of Earth's magnetic field. Rather than nulling out the Earth's magnetic field over the entire facility, we present a new way to correct particle trajectories using much more spatially limited Helmholtz coils. This approach is versatile and easy to incorporate in a wide range of facilities, including the existing ones, enabling measurements of low-energy charged particles in a laboratory beamline.

[Nontuberculous mycobacteria infection and pulmonary alveolar proteinosis in a patient with hematopoietic defects]

A 28-year-old male with a history of leukopenia was admitted with complaints of fever, cough, and dyspnea for 3 months. Initial work-up identified reduced circulating levels of granulocytes, monocytes, lymphocytes, and NK cells. Computed tomography revealed bilateral reticulonodular opacities and mediastinal lymph node enlargement. Peripheral blood culture and mediastinal lymph node aspiration yielded Mycobacterium avium. Genetic testing revealed a heterozygous germline GATA2 mutation (c.1187G>A, R396Q). Despite standard anti-mycobacterial therapy, the patient's dyspnea worsened and subsequent imaging studies revealed diffuse ground-glass opacification. A transbronchial lung biopsy confirmed the development of pulmonary alveolar proteinosis. Bone marrow transplantation had not been performed due to the unavailability of suitable donors. The disease progressed after whole lung lavage, and the patient died at the age of 31 years from respiratory failure. The current case report emphasized the importance of raising awareness about the rare GATA2 deficiency, which is characterized by hematologic abnormalities, primary immunodeficiency, and pulmonary alveolar proteinosis.

[Clinical and pathological features and differential diagnosis of fibro-osseous tumors and dysplasias]

Fibro-osseous lesions is a class of diseases with obvious similarities in clinical manifestations and pathological features, which has been attracting the attention of clinicians and pathologists. The latest WHO 2022 Classification (5th edition) included six of these diseases (cemento-osseous dysplasia, segmental odontomaxillary dysplasia, fibrous dysplasia, juvenile trabecular ossifying fibroma, psammomatoid ossifying fibroma and familial gigantiform cementoma) in the " fibro-osseous tumours and dysplasias ", and put forward new ideas on the diagnosis and treatment of these diseases. According to the latest WHO 2022 Classification (5th edition), the clinical and pathological features, diagnosis and differential diagnosis of these six diseases were described.

[Research progress of tunneling nanotube in bone biology]

Tunneling nanotube (TNT) is a newly discovered communication mode between animal cells in recent years, which have important physiological and pathological significance. However, the role of TNT in bone biology is still unclear. At present, there are many reports about tunneling nanotubes in bone marrow mesenchymal stem cells, osteoclast precursor cells, osteoblasts and immune cells. This review describes the research advances of TNT and its research progress in bone biology. It looks forward to the research direction of TNT in oral and maxillofacial bone development and bone biology, to provide new strategies for the maintenance of bone homeostasis and the treatment of bone diseases.

Response of sugar metabolism in the cotyledons and roots of Ricinus communis subjected to salt stress

Ricinus communis is an important oilseed crop worldwide and is also considered one of the best potential plants for salt-affected soil improvement in northeast China. However, little is known about photosynthesis and carbohydrate metabolism in this plant, nor the distribution of carbohydrates in cotyledons and roots under salinity stress. In the present study, seedling growth, gas exchange parameters (P_N , E, g_s and C_i ), carbohydrate (fructose, sucrose, glucose, soluble sugar and starch) metabolism and related enzymes and genes were measured in Ricinus plants. Under salt stress, P_N of cotyledons decreased significantly (P < 0.05), resulting in weak photosynthetic capacity. Furthermore, salt stress increased sucrose and glucose content in cotyledons, but decreased soluble sugar and starch content. However, sucrose increased and starch decreased in roots. This may be correlated with the increasing sugar metabolism under salinity, including notable changes in sugar-related enzyme activities (SPS, SuSy, α-amylase and β-amylase) and gene expression of RcINV, RcSUS, RcAmY, RcBAM and RcGBE1. The results suggest that salinity reduces photosynthesis of cotyledons, alters carbohydrate allocation between cotyledons and roots and also promotes starch utilization in cotyledons and starch biosynthesis in roots, leading to a functional imbalance between cotyledons and roots. Together, these findings provide insights into the crucial role of sugar metabolism in improving salt-tolerance of Ricinus during the early seedling growth stage.

Relationship between Social Support, Sarcopenia, and Cognitive Impairment in Chinese Community-Dwelling Older Adults

BACKGROUND

Cognitive impairment and sarcopenia have become important challenges for the growing aging population. Social support has been shown to protect against cognitive impairment, but its impact on sarcopenia remains unknown. The purpose of this study was to explore the correlation between social support, sarcopenia, and cognitive impairment in Chinese older adults.

METHOD

A multi-stage whole group sampling method was used to conduct a cross-sectional survey of 720 community-dwelling older people in Shanghai. The definition of sarcopenia was in accordance with the criteria of the Asian Working Group for Sarcopenia (AWGS) 2019. Cognitive impairment was evaluated using a computerized neuropsychological assessment device that had been previously validated. Social support was assessed using the Social Support Rate Scale. Logistic regression analyses were conducted to explore the relationship between social support cognitive impairment and sarcopenia, fully adjusting for all potential confounding factors.

RESULTS

Our study found that 230 (31.94%) of the participants had cognitive impairment and 97 (13.47%) of the participants had sarcopenia. The mean social support score was 35.10 ± 7.54. Besides, the results showed that cognitive impairment was associated with sarcopenia (OR:1.650, 95% CI: 1.048, 2.596, P=0.030) after adjusting for confounding factors. Older adults with high level social support had the lowest risk of cognitive impairment (OR: 0.297, 95% CI: 0.115, 0.680, P=0.021) and sarcopenia (OR: 0.113, 95% CI: 0.031, 0.407, P=0.001), respectively.

CONCLUSION

Our analysis revealed that high level social support was negatively associated with sarcopenia and cognitive impairment. These findings provide strong support for the health promotion effect of social networks against sarcopenia and cognitive impairment in Chinese community-dwelling older adults, with important implications for healthcare policy makers.

Detection Analysis of Perioperative Plasma and CSF Reveals Risk Biomarkers of Postoperative Delirium of Parkinson's Disease Patients Undergoing Deep Brain Stimulation of the Subthalamic Nuclei

Objective

This study aimed to explore possible biomarkers of postoperative delirium (POD) of Parkinson's disease (PD) patients received deep brain stimulation (DBS) of the subthalamic nuclei.

Materials and methods

This nested case control study analyzed perioperative plasma and cerebral spinal fluid (CSF) of patients (n = 40) who developed POD undergone DBS surgery (n = 10) and those who did not (n = 30). Blood sample was collected before surgery and on the first day postoperative, CSF sample was collected at the beginning of the operation. POD was assessed by the Confusion Assessment Method (CAM) twice a day between 7:00 am and 7:00 pm after the surgery until discharge. Plasma and CSF sample from the two groups were analyzed to investigate possible biomarkers for POD in PD patients.

Results

There was no difference between POD and Non-POD groups on the concentration of Interleukin 6 and Tumor Necrosis Factor-α in CSF, preoperative plasma and postoperative plasma. There was no difference between POD and Non-POD groups on the concentration of S100 calcium-binding protein β protein (S100β) and Neurofilament light chain (NFL) in preoperative plasma and postoperative plasma. The concentration of C-reactive protein (CRP), NFL and S100β were significant higher in POD group than non-POD group in CSF. The concentration of CRP was significantly higher in POD group than non-POD group in preoperative plasma and postoperative plasma. CSF concentration of S100β might be a potential biomarker for POD via the receiver operating characteristic curve analysis and the area under the curve value of 0.973.

Conclusion

For PD patients received DBS surgery, CSF S100β might be a marker for aiding detection of high-risk patients with delirium. This requires further confirmation in clinical trials.

[Changes of the World Health Organization 2022 classification (5th edition) of salivary glands tumors]

Pathological diagnosis of salivary gland tumors is one of the most challenging areas in all head and neck surgical pathology. The classification of salivary gland tumors was updated in the 5th edition of the World Health Organization Classification of Head and Neck Tumours, most of which were based on their molecular pathological characteristerics. This new classification features a description of several new entitiesamong benign and malignant neoplasms, salivary gland tumors with updated naming or diagnostic criteria, and lesions deleted from this section, etc.This present review focuses on the updates and changes in the new classification of salivary gland tumors, and provides some reference for head and neck surgeons and pathologists.

Activation of PI3K/Akt prevents hypoxia/reoxygenation-induced GnRH decline via FOXO3a

Recent studies have suggested that the hypothalamus has an important role in aging by regulating nuclear factor-κB (NF-κB)-directed gonadotropin-releasing hormone (GnRH) decline. Moreover, our previous study has shown that ischemia-reperfusion (IR) injury activates NF-κB to reduce hypothalamic GnRH release, thus suggesting that IR injury may facilitate hypothalamic programming of system aging. In this study, we further examined the role of phosphoinositide 3-kinase (PI3K)/Protein kinase B (Akt) pathway, a critical intracellular signal pathway involved in the repair process after IR, in hypoxia-reoxygenation (HR)-associated GnRH decline in vitro. We used GT1-7 cells and primarily-cultured mouse GnRH neurons as cell models for investigation. Our data revealed that the activation of the PI3K/Akt/Forkhead box protein O3a (FOXO3a) pathway protects GnRH neurons from HR-induced GnRH decline by preventing HR-induced gnrh1 gene inhibition and NF-κB activation. Our results further the understanding of the regulatory mechanisms of HR-associated hypothalamic GnRH decline.

OP0113 FUNCTIONAL GENOMICS IN PRIMARY T CELLS AND MONOCYTES IDENTIFIES MECHANISMS BY WHICH GENETIC SUSCEPTIBILITY LOCI INFLUENCE SYSTEMIC SCLEROSIS RISK

Background

Systemic sclerosis (SSc) is a complex autoimmune disease with a strong genetic component. However, the underlying mechanism by which genetics increase disease risk is still unknown. The most recent GWAS studies have identified 27 independent signals associated to SSc [1]. However, the majority of these signals affect regulatory elements that can regulate genes often located hundreds of kilobases away.

The challenge in the post-GWAS era is to use functional genomics to translate genetic findings into patients’ benefit, particularly in disease-relevant cell types.

Objectives

In this study we use chromatin conformation and gene expression analysis in patient derived primary cells and healthy individuals to assess potential mechanisms by which GWAS variants increase disease risk. We identify the potentially affected genes in a cell type specific manner and potential drug targets already in use or with potential for re-purposing.

Methods

Promoter capture Hi-C (pCHi-C) and RNA sequencing experiments were performed in a total of 15 CD4+ T cells and CD14+ monocytes samples each isolated from peripheral blood from SSc patients and healthy controls. We linked SSc-associated variants with their target genes and performed differential expression and differential interaction analyses between both cell types. Potential drug targets were identified using a protein-protein interaction model and queried against the OpenTargets database.

Results

We linked SSc-associated loci to 39 new potential target genes, confirming 7 previously assigned genes. We highlight novel causal genes, such as CXCR5 as the most probable candidate gene for the DDX6 locus (Figure 1). We confirm some previously linked SSc genes such as IRF8, STAT4, or CD247 which interestingly showed cell type specific interactions. We also identified 15 potential drug targets already in use in other similar immune-mediated diseases that could be repurposed for SSc treatment. Furthermore, we observed that interactions are directly related with the expression of important genes implicated in cell type specific pathways.

Figure 1.

Promoter Capture Hi-C interactions linking the DDX6 GWAS loci with the promoter of CXCR5 in CD4+ T cells and CD14+ monocytes. CD4+ T cells show significantly stronger interactions as well as CXCR5 gene expression.

Conclusion

Our study reveals potential causal genes for SSc-associated loci, some of them acting in a cell type specific manner, suggesting novel drug targets and biological mechanisms that may mediate SSc pathogenesis.

References

[1]López-Isac E, Acosta-Herrera M, Kerick M, et al (2019) GWAS for systemic sclerosis identifies multiple risk loci and highlights fibrotic and vasculopathy pathways. Nat Commun 10:. https://doi.org/10.1038/s41467-019-12760-y

Acknowledgements

This work was supported by the Spanish Ministry of Science and Innovation (grants RTI2018101332-B-100 and SAF2015-66761-P), the Cooperative Research Thematic Network (RETICS) programme (RD16/0012/0013) (RIER) from Instituto de Salud Carlos III (ISCIII, Spanish Ministry of Economy, Industry and Competitiveness), the Wellcome Trust (award references 207491/Z/17/Z and 215207/Z/19/Z), Versus Arthritis (award reference 21754), and the NIHR Manchester Biomedical Research Centre. DGS was supported by the Spanish Ministry of Economy and Competitiveness through the FPI programme (SAF2015-66761-P).

Disclosure of Interests

None declared

POS0035 GENE REGULATION IN T-CELLS FROM PsA PATIENTS DIFFERS BETWEEN PERIPHERAL BLOOD AND THE INFLAMED JOINTS: IMPLICATIONS FOR THE INTERPRETATION OF GWAS SIGNALS

Background

Genome-wide association studies (GWAS) have identified variants that are associated with complex diseases such as Psoriatic Arthritis (PsA). The majority of these variants do not affect the coding sequence of proteins but rather regulatory elements which are highly cell type and state specific, and can affect distally located genes via chromatin interaction mechanisms.

We and others have previously analysed GWAS loci for multiple conditions (including PsA and Rheumatoid Arthrtitis) in cell lines using functional genomics techniques, providing putative mechanisms to many loci with previously unknown function [1].

However, multiple studies have identified large differences in gene regulatory mechanisms between cell lines and primary cells, which could significantly alter the proposed mechanisms. Differences between between samples from healthy volunteers and patients, in particular from the affected tissue, have although not been exhaustively investigated.

Objectives

To assess the impact of using primary cells derived from PsA patients compared to healthy volunteers in functional genomics studies.

Methods

CD4+ and CD8+ T cells were isolated from peripherial blood from 10 healthy controls and 48 PsA patients and from 6 PsA synovial fluid samples.

We performed RNA-seq and ATAC-seq on these two cell types to analyse the global patterns of gene expression and chromatin activity.

Results

We find subtle differences between PsA patients and healthy controls in cells isolated from blood. RNA-seq analysis identified only a handful of differentially expressed genes whilst ATAC-seq analysis identified only 28 differential loci.

On the other hand, T cells isolated from synovial fluid showed significant differences compared to T cells isolated from patient’s blood. Interestingly, we find that CD4+ T cells show substantially more differentially expressed genes compared to CD8+ T cells (1168 vs 346 Log2FoldChange > 1, FDR < 0.01). Genes overexpressed in synovial CD4+ T cells are more strongly enriched for immune pathways such as cytokine signaling and T cell proliferation compared to synovial CD8+ T cells

We also find that synovial CD4+ T cells highly overexpress MHC class II genes (Figure 1).

Figure 1.

Normalized counts of the alpha chains of MHC class 2 genes in CD4+ and CD8+ T cells purified from blood from healthy subjects and patients and synovial fluid.

Conclusion

This preliminary analysis suggests that T cells isolated from peripherial blood do not seem to differ significantly between PsA patients and healthy controls. In contrast, cells isolated from synovial fluid are highly specialized and activated. Moreover, these cells do not resemble canonically activated T cells which means that this state can not be easily emulated in vitro.

This study indicates the importance of not only studying GWAS loci in relevant primary cells from patients, but also that attention needs to be given to cells isolated from the affected site.

References

[1]Shi C, Ray-Jones H, Ding J, et al (2021) Chromatin Looping Links Target Genes with Genetic Risk Loci for Dermatological Traits. J Invest Dermatol 141:1975–1984. https://doi.org/10.1016/J.JID.2021.01.015

Acknowledgements

This work was funded by the Wellcome Trust (award references 207491/Z/17/Z and 215207/Z/19/Z), the Versus Arthritis (award reference 21754), the NIHR Manchester Biomedical Research Centre, and the Medical Research Council (award reference MR/N00017X/1).

Disclosure of Interests

None declared

OP0222 IDENTIFICATION OF CAUSAL GENES AND MECHANISMS BY WHICH GENETIC VARIATION MEDIATES JUVENILE IDIOPATHIC ARTHRITIS SUSCEPTIBILITY USING FUNCTIONAL GENOMICS AND CRISPR-CAS9

Background

We recently performed the largest juvenile idiopathic arthritis (JIA) genome-wide association study (GWAS) to date 1. Disease-associated loci contain multiple single nucleotide polymorphism (SNPs), and the majority map to non-coding enhancers, making it challenging to define causal variants and genes.

Functional genomics datasets in disease-relevant tissues have shown to be essential for the functional interpretation of GWAS loci. In particular, capture Hi-C (CHi-C) has been successful in detecting chromosomal interactions linking GWAS loci to their target genes. However, such datasets are lacking in JIA.

Objectives

The aim of this study is to bridge this gap and advance the knowledge of the biological mechanisms that underpin susceptibility to JIA, by integrating GWAS with public epigenomics datasets and in-house generated CHi-C from JIA patients. We focus on CD4+ T-cells, which have been shown to be one of the most relevant cell types in JIA. In addition, we use CRISPR-Cas9 to validate the regulatory effect of prioritised variants on their predicted target genes.

Methods

Credible SNP sets for the top JIA risk loci (P < 5x10-6) were annotated using EpiMap data 2. Low input whole genome promoter CHi-C (PCHi-C) was performed on CD4+ T-cells isolated from blood from 3 JIA oligoarthritis patients, and data was analysed using CHiCAGO 3. GWAS and PCHi-C data were combined to prioritise causal genes using the Capture Hi-C Omnibus Gene Score (COGS) pipeline 4. We subsequently employed CRISPR activation (CRISPRa) and CRISPR interference (CRISPRi) in Jurkats to assess whether prioritized JIA variants were capable of regulating the expression of the interacting genes.

Results

614 credible SNPs (out of 735) were found to overlap active enhancers in CD4+ T-cells, and were prioritized for further analysis.

We identified numerous significant chromatin interactions in 19 out of 44 non-MHC JIA associated loci, linking JIA SNPs mapping to T-cell enhancers to a total of 61 target genes and revealing potential novel disease pathways. Moreover, COGS prioritised a total of 7 genes (RGS14, ERAP2, HIPK1, CCR4, CCRL2, CCR2, CCR3).

A JIA associated locus on chromosome 3 contains 39 SNPs. It maps to an intergenic region and the causal gene/s are unclear. Our PCHi-C data revealed that this JIA locus presents chromatin interactions with the promoters of several genes, such as CCRL2, CCR2, CCR3 and CCR5, three of which were prioritised by COGS. Two variants were selected for further analysis: rs79815064, which had the highest posterior probability, and rs8005404,the only variant within a CD4+ T-cell enhancer linked to surrounding gene activity.

When both SNPs were targeted with CRISPRa and CRISPRi, we observed an increased and decreased expression, respectively, of CCRL2, CCR2, CCR3 and CCR5, confirming their role in disease. These genes belong to the chemokine receptor family and are important regulators of the inflammatory response.

Conclusion

Our work shows how functional genomics can help identify biological mechanisms by which GWAS variants increase risk of JIA, which in turn will benefit patients through personalised medicine and the identification of therapeutic targets.

References

[1]López-Isac, E. et al. Combined genetic analysis of juvenile idiopathic arthritis clinical subtypes identifies novel risk loci, target genes and key regulatory mechanisms. Ann. Rheum. Dis.80, 321–328 (2021).

[2]Boix, C. A., James, B. T., Park, Y. P., Meuleman, W. & Kellis, M. Regulatory genomic circuitry of human disease loci by integrative epigenomics. Nat. 2021 5907845590, 300–307 (2021).

[3]Cairns, J. et al. CHiCAGO: Robust detection of DNA looping interactions in Capture Hi-C data. Genome Biol.17, 1–17 (2016).

[4]Javierre, B. M. et al. Lineage-Specific Genome Architecture Links Enhancers and Non-coding Disease Variants to Target Gene Promoters. Cell167, 1369 (2016).

Disclosure of Interests

Antonio Frantzesko: None declared, Valeriya Malysheva: None declared, Chenfu Shi: None declared, James Ding: None declared, John Bowes: None declared, Wendy Thomson: None declared, Stephen Eyre: None declared, Mikhail Spivakov Shareholder of: co-founder and shareholder of Enhanc3D Genomics Ltd, Gisela Orozco: None declared

A High Energy X-ray Diffraction Study of Amorphous Indomethacin

Amorphous pharmaceuticals often possess a wide range of molecular conformations and bonding arrangements. The x-ray pair distribution function (PDF) method is a powerful technique for the characterization of variations in both intra-molecular and inter-molecular packing arrangements. Here, the x-ray PDF of amorphous Indomethacin is shown to be particularly sensitive to the preferred orientations of the chlorobenzyl ring found in isomers in the crystalline state. In some cases, the chlorobenzyl ring has no preferred torsional angle in the amorphous form, while in others evidence of distinct isomer orientations are observed. Amorphous samples with no preferred torsion angles of the chlorobenzyl ring are found to favor enhanced inter-molecular hydrogen bonding, and this is reflected in the intensity of the first sharp diffraction peak. These significant variations in structure rule out amorphous Indomethacin as a possible standard for x-ray PDF measurements. At high humidity, time resolved PDF's for >40 h reveal water molecules forming hydrogen bonds with Indomethacin molecules. A simple linear hydrogen bond model indicates that water molecules in the wet amorphous form have similar hydrogen bond strengths to those found between Indomethacin dimers or chains in the dry amorphous form.

Cholecystokinin octapeptide improves hippocampal glutamatergic synaptogenesis and postoperative cognition by inhibiting induction of A1 reactive astrocytes in aged mice

Aims

Delayed neurocognitive recovery (dNCR) is a common postoperative complication in geriatric surgical patients for which there is no efficacious therapy. Cholecystokinin octapeptide (CCK‐8), an immunomodulatory peptide, regulates memory and learning. Here, we explored the effects and mechanism of action of CCK‐8 on dNCR.

Methods

We applied laparotomy to establish a model of dNCR in aged mice. Morris water maze and fear conditioning tests were used to evaluate cognition. Immunofluorescence was used to detect the density of CCK‐8, A1 reactive astrocytes, glutamatergic synapses, and activation of microglia in the hippocampus. Quantitative PCR was performed to determine mRNA levels of synapse‐associated factors. A1 reactive astrocytes, activated microglia, and glutamatergic synapse‐associated protein levels in the hippocampus were assessed by western blotting.

Results

Administration of CCK‐8 suppressed the activation of microglia, the induction of A1 reactive astrocytes, and the expression of tumor necrosis factor alpha, complement 1q, and interleukin 1 alpha in the hippocampus. Furthermore, it promoted glutamatergic synaptogenesis and neurocognitive recovery in aged dNCR model mice.

Conclusion

Our findings indicated that CCK‐8 alleviated cognitive impairment and promoted glutamatergic synaptogenesis by inhibiting the induction of A1 reactive astrocytes and the activation of microglia. CCK‐8 is, therefore, a potential therapeutic target for dNCR.

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

BACKGROUND

Circadian rhythm disturbance is common postoperatively in older patients with hip fractures, which may contribute to the development of postoperative delirium (POD). As a reliable biomarker of endogenous circadian rhythms, melatonin regulates the sleep-wake cycle and environmental adaptation, and its secretory rhythm may be modified by anaesthesia and surgery. This study compared the impact of subarachnoid anaesthesia (SA) and general anaesthesia (GA), on the peak of melatonin secretion (primary outcome), the circadian rhythm of melatonin, cortisol and sleep, and the POD incidence (secondary outcome).

METHODS

In this prospective cohort observational study, hip fracture surgery patients were enrolled and assigned to receive either SA or GA. Postoperative plasma melatonin and cortisol levels were dynamically measured every six hours on seven time-points, and the circadian rhythm parameters including mesor, amplitude, and acrophase were calculated. Subjective and objective sleep assessments were performed by sleep diaries and sleep trackers, respectively. The Confusion Assessment Method was used twice daily by a specific geriatrician to screen for POD occurrence.

FINDINGS

In a cohort of 138 patients who underwent hip fracture surgery, the circadian rhythm disruption of the patients in the GA group (n=69) was greater than the SA group (n=69). Compared with SA, GA provided the lower peak concentration, mesor, and amplitude of melatonin secretion on postoperative day 1 (p < 0.05). Patients in the GA group experienced higher awakenings, more sleep deprivation, and poor sleep quality on surgery day (p < 0.05). A proportion of 12 patients in the SA group (17.4%) and 24 patients in the GA group (34.8%) experienced POD (p = 0.020).

INTERPRETATION

These results suggest that SA may be superior to GA in elderly patients undergoing hip fracture surgery as SA is associated with less impairment of the melatonin rhythm and sleep patterns, and fewer POD occurrences.

FUNDING

The study was supported by the National Natural Science Foundation of China (81971012, 81873726, 81901095, 81701052, and 81801070), Key Clinical Projects of Peking University Third Hospital (BYSYZD2019027), and Peking University "Clinical Medicine plus X" Youth Project (PKU2020LCXQ016).

JNK inhibition alleviates delayed neurocognitive recovery after surgery by limiting microglia pyroptosis

Delayed neurocognitive recovery (dNCR) is a prevalent complication after surgery in older adults. Neuroinflammation plays a pivotal role in the pathogenesis of dNCR. Recently,compelling evidence suggests that theinvolvement of microglia pyroptosis in the regulation of neuroinflammation in neurologicaldiseases. Nevertheless, the exact role of microglia pyroptosis in dNCR remains elusive. In the study, in vitro and in vivo models of dNCR were used to examine the potential effects of the mitogen‑activated protein kinase signaling pathway on Nod-like receptor protein 3 (NLRP3) inflammasome-mediated microglia pyroptosis and cognitive deficits following surgery. In vivo, we observed surgery-induced upregulation of phosphorylated (p)-c-Jun N-terminal kinases (JNK) in microglia and subsequently NLRP3 inflammasome activation, pyroptosis, and inflammatory cytokines release in mice hippocampus. Interestingly, JNK inhibitor SP600125 significantly attenuated surgery-induced cognitive impairments through inhibiting pyroptosis, inflammatory responses, and reducing immunoreactivity of NLRP3 and gasdermin D N terminus (GSDMD-N) in hippocampal microglia. In vitro, NLRP3 inflammasome- and pyroptosis-associated proteins and immunoreactivity of NLRP3, GSDMD-N, and interleukin-1β were activated in BV2 microglial cells following lipopolysaccharide (LPS) stimulation. These effects were significantly suppressed in BV2 cells by SP600125 treatment. Furthermore, treatment with NLRP3 specific inhibitor, MCC950, attenuated microglia pyroptosis induced by LPS, but did not rescue LPS-induced increased expression of p-JNK. These results indicate that the JNK pathway is largely upstream of the NLRP3 inflammasome, which exerts a crucial regulatory impact on microglia pyroptosis and inflammatory responses, thus providing a promising avenue to prevent dNCR.

Hundred most cited articles in perioperative neurocognitive disorder: a bibliometric analysis

Background

In line with aging populations and increased application of anesthesia and surgery, perioperative neurocognitive disorder (PND) has received growing attention worldwide. Considerable researches into PND are being conducted; however, the quantity and quality of such researches have not been reported. Through a retrospective bibliometric analysis, this study aims to identify and characterize the top 100 cited publications on PND.

Methods

We searched the Web of Science database to find the top 100 cited articles focusing on PND. We collected bibliographic information, including year of publication, country of origin, article type, published journal, citation count, and authorship. To determine changes with time, we compared older and newest articles.

Results

The top 100 cited articles were published between 1955 and 2016; the number of citations ranged from 111 to 1248. The United States had the most published papers; clinical trial was the most common article type. The specialty journals of Anesthesiology and Anesthesia & Analgesia were the two most cited journals. Newest articles had a comparable number of citations to older articles, but the former had higher annual citation rates, greater funding disclosures, more focus on basic research, and more open access publications.

Conclusions

This study provides a comprehensive overview of the most cited articles and highlights the increasing attention on PND. High-quality clinical trials with a greater journal impact factor receive more citations. However, there has been a growth in the number of basic science studies as an area of research with respect to the pathogenesis of PND.

[Value of the application of enhanced CT radiomics and machine learning in preoperative prediction of microvascular invasion in hepatocellular carcinoma]

Objective: To explore the value of machine learning models in preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) based on dual-phase contrast-enhanced CT radiomics features. Methods: The data of 148 patients [106 males and 42 females, with an average age of (58±11) years] with HCC confirmed by pathology in the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were retrospectively analyzed, including 88 cases of positive MVI and 60 cases of negative MVI. According to the ratio of 7∶3, the patients were randomly divided into the training and validation sets, respectively. The three-dimensional (3D) radiomics features of HCC in arterial phase (AP) and portal venous phase (PP) were extracted by MaZda software, and the optimal feature subset was obtained by combining three feature selection methods (FPM method) and Lasso regression. Then, six machine learning methods were used to build the prediction models. Receiver operating characteristic (ROC) curves were drawn to evaluate the prediction ability of the aforementioned models, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. Results: Radiomics features of HCC in AP and PP were extracted by MaZda software, with 239 in each phase. There were 7 optimal features in AP and 14 optimal features in PP selected by FPM method and Lasso regression, respectively. The AUCs of decision tree, extreme gradient boosting, random forest, support vector machine (SVM), generalized linear model, and neural network based on the 7 optimal features in AP in the validation set were 0.736, 0.910, 0.913, 0.915, 0.897, 0.648, respectively. The SVM had the highest AUC in the validation set, with the accuracy, sensitivity and specificity of 95.35%, 95.83% and 94.74%, respectively. Likewise, the AUCs of machine learning models in prediction of MVI in HCC based on the 14 optimal features in PP in the validation set were 0.873, 0.876, 0.913, 0.859, 0.877, 0.834, respectively, and there were no significant differences (all P>0.05). The random forest had the highest AUC in the validation set, with the accuracy, sensitivity and specificity of 90.70%, 87.50% and 94.74%, respectively. Conclusion: Machine learning models based on dual-phase enhanced CT radiomics features can be used in preoperative prediction of MVI in HCC, particularly the SVM and random forest models have high prediction efficiency.

LncRNA OTUD6B-AS1 inhibits many cellular processes in colorectal cancer by sponging miR-21-5p and regulating PNRC2

Accumulating evidence has revealed that long noncoding RNAs (lncRNAs) play essential roles in regulating cellular process of various cancers. There have been many studies on the biological functions of lncRNAs in colorectal cancer (CRC). In this research, we explored the role and mechanism of lncRNA ovarian tumor domain containing 6B antisense RNA1 (OTUD6B-AS1) in CRC. Here, we detected OTUD6B-AS1 expression in CRC tissues and cells by RT-qPCR. Functional experiments were performed to test alterations in different cellular processes. Moreover, to verify the binding ability among the indicated RNA molecules, we carried out RIP, RNA pull-down and luciferase reporter assays. According to our data, OTUD6B-AS1 expression was low in CRC tissues and cells. Functionally, overexpression of OTUD6B-AS1 inhibited cell proliferation, migration, invasion and EMT, and promoted cell apoptosis. Bioinformatic analysis and mechanistical experiments confirmed that OTUD6B-AS1 could act as a competitive endogenous RNA (ceRNA) to upregulate Proline-Rich Nuclear Receptor Coactivator 2 (PNRC2) expression by sequestering miR-21-5p. Further rescue experiments validated the inhibitory function of the OTUD6B-AS1/miR-21-5p/PNRC2 axis in cellular process of CRC. Overall, OTUD6B-AS1 inhibits cellular development in CRC by sponging miR-21-5p and upregulating PNRC2, providing a novel insight into the exploration on CRC treatment.

The Non-peptide Angiotensin-(1-7) Mimic AVE 0991 Attenuates Delayed Neurocognitive Recovery After Laparotomy by Reducing Neuroinflammation and Restoring Blood-Brain Barrier Integrity in Aged Rats

Delayed neurocognitive recovery (dNCR) after surgery is a common postoperative complication in older adult patients. Our previous studies have demonstrated that cognitive impairment after surgery involves an increase in the brain renin-angiotensin system (RAS) activity, including overactivation of the angiotensin 2/angiotensin receptor-1 (Ang II/AT1) axis, which provokes the disruption of the hippocampal blood-brain barrier (BBB). Nevertheless, the potential role of the counter-regulatory RAS axis, the Ang-(1–7)/Mas pathway, in dNCR remains unknown. Using an aged rat model of dNCR, we dynamically investigated the activity of both axes of the RAS following laparotomy. AVE 0991, a nonpeptide analog of Ang-(1–7), was administered intranasally immediately after laparotomy. We found that the elevation of Ang II, induced by surgery was accompanied by a decrease of Ang-(1–7) in the hippocampus, but not in the circulation. Surgery also significantly downregulated hippocampal Mas receptor expression at 24 h postsurgery. Mas activation with intranasal AVE 0991 treatment significantly improved hippocampus-dependent learning and memory deficits induced by surgery. Furthermore, it attenuated hippocampal neuroinflammation, as shown by the decreased level of the microglial activation marker cluster of differentiation 11b (CD11b) and the decreased production of several inflammatory molecules. Along with these beneficial effects, the AVE 0991 treatment also alleviated the imbalance between matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-3 (TIMP-3), modulated the expression of occludin, and alleviated the IgG extravasation, thereby restoring the integrity of the BBB. In conclusion, these data indicate that activation of Mas by AVE 0991 attenuates dNCR after surgery by reducing neuroinflammation and restoring BBB integrity. Our findings suggest that the Ang-(1–7)/Mas pathway may be a novel therapeutic target for treating dNCR after surgery in older adult patients.

Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial

INTRODUCTION

Postoperative delirium (POD) is a common neurological complication after hip fracture surgery and is associated with high morbidity and mortality in elderly patients. Although the specific mechanism of POD remains unclear, circadian rhythm disruptions have recently drawn increased attention. To date, only limited postoperative time points of plasma melatonin level measurements were recorded in previous studies, and such data cannot represent a comprehensive melatonin rhythm. The process of anaesthesia (either general anaesthesia (GA) or regional anaesthesia (RA)) is known to influence the melatonin rhythm. However, how these two anaesthesia methods differently affect the postoperative melatonin rhythm is still unknown. Therefore, we hypothesise that RA may attenuate the disruption of the melatonin rhythm, which might decrease the incidence of POD in elderly patients undergoing hip surgery.

METHODS AND ANALYSIS

In this prospective cohort clinical trial, 138 patients scheduled for hip fracture surgery will be divided into two groups to receive either GA or RA. The primary aim is to compare the circadian rhythm of melatonin secretion between the two groups and explore its association with the incidence of POD.

ETHICS AND DISSEMINATION

The study has been approved by the Medical Science Research Ethics Committees of Beijing Jishuitan Hospital (JLKS201901-04). The results of the study will be published in peer-reviewed international journals.

TRIAL REGISTRATION NUMBER

ChiCTR1900027393.

MiR-221 affects the proliferation and apoptosis of laryngeal cancer cells through the PI3K/AKT signaling pathway

OBJECTIVE

To investigate the effect of MiR-221 on proliferation and apoptosis of laryngeal carcinoma cells through the PI3K/AKT signaling pathway.

MATERIALS AND METHODS

LipofectamineTM 2000 liposomes were used to transfer MiR-221 analogue, MiR-221 NC into Hep-2 cells of laryngeal carcinoma. Real-time fluorescence quantitative polymerase chain reaction (PCR) method was used to detect the expression of MiR-221, MTT method was used to detect the proliferation of cells, flow cytometry was used to detect cell cycle, Western blotting was used to detect the expression of apoptosis proteinase-1 (Apaf-1) and cyclin-dependent kinase (CDK1, CDK2) protein and the activation of phosphatidylinositol 3 kinase (PI3K)/protein kinase B (AKT).

RESULTS

Compared with MiR-221 NC group, the expression of MiR-221 in MiR-221 analogue group was up-regulated (p<0.01), the cell proliferation rate was decreased (p<0.01), the cell cycle was stagnated in the G1 phase (p<0.01), the expression levels of Cyclin A, CDK1, CDK2, PI3K, and p-AKT were significantly down-regulated (p<0.01), and the expression levels of Bax and Apaf-1 were significantly up-regulated (p<0.01).

CONCLUSIONS

MiR-221 analogues can significantly inhibit the proliferation and induce apoptosis of Hep-2 cells in laryngeal cancer, and this is achieved by blocking the PI3K/AKT signaling pathway, which also indicates that MiR-221 affects the proliferation and apoptosis of laryngeal cancer cells through the PI3K/AKT signaling pathway.

Melatonin ameliorates the sleep disorder induced by surgery under sevoflurane anaesthesia in aged mice

Post-operative sleep disorders induce adverse effects on patients, especially the elderly, which may be associated with surgery and inhalational anaesthetics. Melatonin is a neuroendocrine regulator of the sleep-wake cycle. In this study, we analysed the alterations of post-operative sleep in aged melatonin-deficient (C57BL/6J) mice, and investigated if exogenous melatonin could facilitate entrainment of circadian rhythm after laparotomy under sevoflurane anaesthesia. The results showed that laparotomy under sevoflurane anaesthesia had a greater influence on post-operative sleep than sevoflurane alone. Laparotomy under anaesthesia led to circadian rhythm shifting forward, altered EEG power density and delta power of NREM sleep, and lengthened REM and NREM sleep latencies. In the light phase, the number of waking episodes tended to decline, and wake episode duration elevated. However, these indicators presented the opposite tendency during the dark phase. Melatonin showed significant efficacy for ameliorating the sleep disorder and restoring physiological sleep, and most of the beneficial effect of melatonin was antagonized by luzindole, a melatonin receptor antagonist.

Construction of porous carbon for the highly efficient visible light-driven degradation methyl violet

A series of nanoporous carbons (NPC) Fe-C/N-900 and C/N-900 have been synthesized from one-step carbonization of 5,10,15,20-tetrakis(4-carboxyphenyl)porphyrin-Fe (Fe-TCPP) and TCPP, respectively and employed as photocatalyst for the degradation of organic dye methyl violet (MV) under UV irradiation. The optimized Fe-C/N-900 (carbonized at 900 oC for 2 h) exhibited an optimal performance in MV degradation. The photodegradation capacity of Fe-C/N-900 has been observed to be higher than that of C/N-900. The photodegradation ability of Fe-C/N-900 as a function of initial MV concentration, catalysis dosage, and pH has been also investigated. The Fe-C/N-900 material showed no apparent loss in MV degradation after four cycles. These features reveal that Fe-C/N-900 may be a promising degradant for dyes removal from water.                     KEY WORDS: Photocatalysis, Nanoporous carbons, Methyl violet, carbonization   Bull. Chem. Soc. Ethiop. 2020, 34(2), 277-284 DOI: https://dx.doi.org/10.4314/bcse.v34i2.6

[A summary of China's 70 years of development in optometric technology]

Since the founding of the People's Republic of China, the optometric technology has developed rapidly. Our peers have created breakthroughs in the field exploration and technology evolution, which have made the optometric technology in China reach the highest level in the world. We review the development and driving force of optometric technology in our country. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. (Chin J Ophthalmol, 2020, 56:721-725).

Tumour biomarkers: association with heart failure outcomes

BACKGROUND

There is increasing recognition that heart failure (HF) and cancer are conditions with a number of shared characteristics.

OBJECTIVES

To explore the association between tumour biomarkers and HF outcomes.

METHODS

In 2,079 patients of BIOSTAT-CHF cohort, we measured six established tumour biomarkers: CA125, CA15-3, CA19-9, CEA, CYFRA 21-1 and AFP.

RESULTS

During a median follow-up of 21 months, 555 (27%) patients reached the primary end-point of all-cause mortality. CA125, CYFRA 21-1, CEA and CA19-9 levels were positively correlated with NT-proBNP quartiles (all P < 0.001, P for trend < 0.001) and were, respectively, associated with a hazard ratio of 1.17 (95% CI 1.12-1.23; P < 0.0001), 1.45 (95% CI 1.30-1.61; P < 0.0001), 1.19 (95% CI 1.09-1.30; P = 0.006) and 1.10 (95% CI 1.05-1.16; P < 0.001) for all-cause mortality after correction for BIOSTAT risk model (age, BUN, NT-proBNP, haemoglobin and beta blocker). All tumour biomarkers (except AFP) had significant associations with secondary end-points (composite of all-cause mortality and HF hospitalization, HF hospitalization, cardiovascular (CV) mortality and non-CV mortality). ROC curves showed the AUC of CYFRA 21-1 (0.64) had a noninferior AUC compared with NT-proBNP (0.68) for all-cause mortality (P = 0.08). A combination of CYFRA 21-1 and NT-proBNP (AUC = 0.71) improved the predictive value of the model for all-cause mortality (P = 0.0002 compared with NT-proBNP).

CONCLUSIONS

Several established tumour biomarkers showed independent associations with indices of severity of HF and independent prognostic value for HF outcomes. This demonstrates that pathophysiological pathways sensed by these tumour biomarkers are also dysregulated in HF.

Intracapsular carcinoma ex basal cell adenoma of the parotid gland

Malignant transformation of basal cell adenoma is extremely rare. We report the case of a 63-year-old Chinese woman, who had noticed a slowing growing mass in her right parotid gland with slight pain for 1 month. Based on physical and ultrasound examinations, a diagnosis of benign salivary gland tumour was made before the surgery. A frozen biopsy was performed, and the diagnosis was basal cell adenoma, with the tumour cells infiltrating the capsule. Routine histopathological examination was performed after the surgery, and a final diagnosis of intracapsular basal cell adenocarcinoma ex basal cell adenoma was made. The patient received a further total parotidectomy and recovered well without any evidence of facial nerve palsy. This case suggests that during frozen biopsy, adequate sectioning including the capsule should be made. With regard to the treatment, we suggest a complete excision of the tumour with tumour-free margins, without any additional auxiliary therapy.

0638 Evaluation of an Oral Drug Pyridostigmine Bromide in Patients with Mild to Moderate Obstructive Sleep Apnea

Introduction

A randomized, double-blind, cross-over, placebo-controlled clinical study with pyridostigmine bromide (PYD) in obstructive sleep apnea (OSA) patients ranging from mild to moderate disease was conducted to evaluate its clinical efficacy and safety.

Methods

Six diagnosed male patients with averages of age 48 yr (38 - 57 yr), BMI 28 (26 - 33), AHI 19.2 (15 - 26.2), minimum oxygen saturation (Min SaO2) 81% (75 - 87%) were enrolled to the study. The study consisted one-night acclimatization period followed immediately by a 2-night double-blind treatment period when subjects received either a single dose of PYD (a cholinesterase inhibitor, 90 mg) or placebo before sleep. Subjects were required to maintain in a supine position, and monitored by a standard polysomnography all the time. Sleep questionnaires (The SMH Sleep Questionnaire and ESS) were taken daily immediately after sleep and at the evening to evaluate the sleep satisfaction and the day-time quality, respectively. Safety of the drug was monitored and evaluated.

Results

Reductions of AHI (28.1%, p &lt; 0.01), apnea index (37.2%, p &lt; 0.05), % of total apnea/hypopnea time (36.4%, p &lt; 0.05) were observed in the treatment group compared with the placebo between 2-7 hours of sleep. Min SaO2 was increased, no change, or decreased by PYD in 3, 2, or 1 subject(s), respectively. PYD was generally well tolerated with minimum minor incidents. Subjects reported to have more satisfied sleep and more clear-headed in the treatment night, and more energy, more concentrated and less sleepy during the daytime following the treatment night.

Conclusion

This study demonstrated the initial effectiveness of the PYD treatment for OSA, indicating that it may provide a new treatment option if the efficacy can be maintained in a large-scale clinical trial.

Support

N/A

A study of optimal concentration range and time window of sevoflurane preconditioning for brain protection in MCAO rats

Background

Sevoflurane preconditioning improves brain function in MCAO rats, and there are several methods for determining appropriate concentration and time windows for preconditioning. This study investigated the brain protective effects with a single sevoflurane preconditioning at different concentrations and different time windows on MCAO rats.

Methods

Adult Sprague-dawley rats were randomly assigned to 14 groups. The rats in the sevoflurane preconditioning group inhaled 0.5 MAC, 1.0 MAC, and 1.3 MAC sevoflurane, respectively for 3 h, and then MCAO models were established at 6 h, 12 h, 24 h, and 48 h. MCAO and sham groups underwent no preconditioning with sevoflurane. The neurological severity score, cerebral infarct volume and brain water content of the rats were measured 24 h after reperfusion.

Results

After inhalation of 1.3 MAC sevoflurane for 3 h of preconditioning, the MCAO model was established after 24 h. This preconditioning improved the neurological severity score, reduce cerebral infarct volume and brain water content in MCAO rats. After inhalation of 1.0 MAC sevoflurane for 3 h of preconditioning, MCAO model established after 24 h reduced the cerebral infarct volume and brain water content of MCAO rats, but the neurological severity score showed no significant improvement, and no significant brain protective effects were observed at other concentrations and time windows.

Conclusions

These results suggested that after inhalation of 1.3 MAC sevoflurane for 3 h of preconditioning, MCAO model established after 24 h demonstrated significant brain protective effects in MCAO rats.