[Correlation between insulin resistance and coronary collateral circulation in patients with chronic total coronary occlusion]

OBJECTIVE

To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism.

METHODS

This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis.

RESULTS

NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways.

CONCLUSION

The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

Luminescence properties and Judd-Ofelt analysis of Tb3+ doped Sr2YTaO6 double perovskite phosphors for white LED applications

A series of Tb3+-doped Sr2YTaO6 double perovskite phosphors (SYT:Tb3+) were synthesized using a conventional solid-state reaction method. A strong green emission was observed in the SYT:Tb3+ phosphors, and the optimal doping concentration of Tb3+ was confirmed to be 5 mol%. The electric dipole-dipole interaction was ascribed to be the main mechanism for the luminescence concentration quenching. Analysis of the concentration-dependent fluorescence decay confirmed that the self-generated quenching model holds for the dynamic process of Tb3+ decays in SYT. Furthermore, the internal quantum efficiencies, non-radiative transition rates, and energy transfer rates of the 5D4 level for the SYT:Tb3+ samples were estimated, respectively. The luminescence thermal stability of the sample was also evaluated based on the Arrhenius model. The chromaticity shift of the SYT:5 mol% Tb3+ phosphor was examined to be 0.013 when the sample temperature was increased from 303 to 483 K, thus indicating excellent chromaticity shifting resistance under high temperature conditions. Moreover, the Judd-Ofelt parameters were calculated from the emission spectra of SYT:Tb3+ to be Ω2 = 0.29 × 10-20, Ω4 = 0.45 × 10-20, and Ω6 = 0.72 × 10-20 cm2, respectively. The fluorescence branching ratios and radiative transition rates for the 5D4 level were calculated based on the obtained Judd-Ofelt parameters. Finally, a white light-emitting diode (LED) prototype was assembled using a 310 nm LED chip combined with a prepared green SYT:Tb3+ phosphor and two other commercial blue and red phosphors. The obtained warm white light exhibits good chromaticity coordinates (0.32, 0.32) and a high color rendering index of 96.1. Based on the above results, it can be known that the prepared SYT:Tb3+ phosphors have a potential application as green emitting phosphors in white LEDs.

Multicolor-emitting Er3+ and Er3+/Yb3+ doped Zn2GeO4 phosphors combining static and dynamic identifications for advanced anti-counterfeiting application

Anti-counterfeiting labels based on luminescence materials are a newly emerging technique for protecting legal goods and intellectual property. In the anti-counterfeiting field to prevent forgery and cloning, luminescence materials with properties different from the commercialized and traditional ones are in urgent need. In this work, multicolor-emitting Er3+ single-doped and Er3+/Yb3+ co-doped Zn2GeO4 phosphors combining static and dynamic identifications were developed in order to achieve advanced anti-counterfeiting application. The variation of trap content with increasing the doping content of rare earth ions was analyzed through X - ray photoelectron spectroscopy, thermoluminescence analysis. It was found that there are two types of traps with different depth in Zn2GeO4 phosphors. The depths of the traps were experimentally confirmed to be 0.68 and 0.79 eV, respectively. The transient photocurrent response measurement confirmed the existence of charge carriers, and the mechanism for long persistent luminescence was deduced. The multicolor upconversion mechanisms under 980 and 1550 nm excitation were also discovered. Based on the multicolor steady and transient emission features, an anti-counterfeiting pattern was designed using the phosphors. Static and dynamic identification was demonstrated and presented in detail. Finally, it is indicated that the studied phosphors are excellent candidates for potential applications in luminescence anti-counterfeiting labels.

Near infrared emissions from both high efficient quantum cutting (173%) and nearly-pure-color upconversion in NaY(WO4)2:Er3+/Yb3+ with thermal management capability for silicon-based solar cells

Raising photoelectric conversion efficiency and enhancing heat management are two critical concerns for silicon-based solar cells. In this work, efficient Yb3+ infrared emissions from both quantum cutting and upconversion were demonstrated by adjusting Er3+ and Yb3+ concentrations, and thermo-manage-applicable temperature sensing based on the luminescence intensity ratio of two super-low thermal quenching levels was discovered in an Er3+/Yb3+ co-doped tungstate system. The quantum cutting mechanism was clearly decrypted as a two-step energy transfer process from Er3+ to Yb3+. The two-step energy transfer efficiencies, the radiative and nonradiative transition rates of all interested 4 f levels of Er3+ in NaY(WO4)2 were confirmed in the framework of Föster-Dexter theory, Judd-Ofelt theory, and energy gap law, and based on these obtained efficiencies and rates the quantum cutting efficiency was furthermore determined to be as high as 173% in NaY(WO4)2: 5 mol% Er3+/50 mol% Yb3+ sample. Strong and nearly pure infrared upconversion emission of Yb3+ under 1550 nm excitation was achieved in Er3+/Yb3+ co-doped NaY(WO4)2 by adjusting Yb3+ doping concentrations. The Yb3+ induced infrared upconversion emission enhancement was attributed to the efficient energy transfer 4I11/2 (Er3+) + 2F7/2 (Yb3+) → 4I15/2 (Er3+) + 2F5/2 (Yb3+) and large nonradiative relaxation rate of 4I9/2. Analysis on the temperature sensing indicated that the NaY(WO4)2:Er3+/Yb3+ serves well the solar cells as thermos-managing material. Moreover, it was confirmed that the fluorescence thermal quenching of 2H11/2/4S3/2 was caused by the nonradiative relaxation of 4S3/2. All the obtained results suggest that NaY(WO4)2:Er3+/Yb3+ is an excellent material for silicon-based solar cells to improve photoelectric conversion efficiency and thermal management.

Neural Global Illumination: Interactive Indirect Illumination Prediction Under Dynamic Area Lights

We propose neural global illumination, a novel method for fast rendering full global illumination in static scenes with dynamic viewpoint and area lighting. The key idea of our method is to utilize a deep rendering network to model the complex mapping from each shading point to global illumination. To efficiently learn the mapping, we propose a neural-network-friendly input representation including attributes of each shading point, viewpoint information, and a combinational lighting representation that enables high-quality fitting with a compact neural network. To synthesize high-frequency global illumination effects, we transform the low-dimension input to higher-dimension space by positional encoding and model the rendering network as a deep fully-connected network. Besides, we feed a screen-space neural buffer to our rendering network to share global information between objects in the screen-space to each shading point. We have demonstrated our neural global illumination method in rendering a wide variety of scenes exhibiting complex and all-frequency global illumination effects such as multiple-bounce glossy interreflection, color bleeding, and caustics.

[Current status of diagnosis and treatment of chronic lymphocytic leukemia in China: A national multicenter survey research]

Objective: To understand the current status of diagnosis and treatment of chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL) among hematologists, oncologists, and lymphoma physicians from hospitals of different levels in China. Methods: This multicenter questionnaire survey was conducted from March 2021 to July 2021 and included 1,000 eligible physicians. A combination of face-to-face interviews and online questionnaire surveys was used. A standardized questionnaire regarding the composition of patients treated for CLL/SLL, disease diagnosis and prognosis evaluation, concomitant diseases, organ function evaluation, treatment selection, and Bruton tyrosine kinase (BTK) inhibitor was used. Results: ①The interviewed physicians stated that the proportion of male patients treated for CLL/SLL is higher than that of females, and the age is mainly concentrated in 61-70 years old. ②Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. ③Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. ④In terms of cognition of high-risk prognostic factors, physicians' knowledge of unmutated immunoglobulin heavy-chain variable and 11q- is far inferior to that of TP53 mutation and complex karyotype, which are two high-risk prognostic factors, and only 17.1% of the interviewed physicians fully mastered CLL International Prognostic Index scoring system. ⑤Among the first-line treatment strategy, BTK inhibitors are used for different types of patients, and physicians have formed a certain understanding that BTK inhibitors should be preferentially used in patients with high-risk factors and elderly patients, but the actual use of BTK inhibitors in different types of patients is not high (31.6%-46.0%). ⑥BTK inhibitors at a reduced dose in actual clinical treatment were used by 69.0% of the physicians, and 66.8% of the physicians had interrupted the BTK inhibitor for >12 days in actual clinical treatment. The use of BTK inhibitors is reduced or interrupted mainly because of adverse reactions, such as atrial fibrillation, severe bone marrow suppression, hemorrhage, and pulmonary infection, as well as patients' payment capacity and effective disease progression control. ⑦Some differences were found in the perceptions and behaviors of hematologists and oncologists regarding the prognostic assessment of CLL/SLL, the choice of treatment options, the clinical use of BTK inhibitors, etc. Conclusion: At present, a gap remains between the diagnosis and treatment of CLL/SLL among Chinese physicians compared with the recommendations in the guidelines regarding the diagnostic criteria, treatment indications, prognosis assessment, accompanying disease assessment, treatment strategy selection, and rational BTK inhibitor use, especially the proportion of dose reduction or BTK inhibitor discontinuation due to high adverse events.

Identification of fatty acid metabolism-related clusters and immune infiltration features in hepatocellular carcinoma

Hepatocellular Carcinoma (HCC) is a type of liver cancer which is characterized by inflammation-associated tumor. The unique characteristics of tumor immune microenvironment in HCC contribute to hepatocarcinogenesis. It was also clarified that aberrant fatty acid metabolism (FAM) might accelerate tumor growth and metastasis of HCC. In this study, we aimed to identify fatty acid metabolism-related clusters and establish a novel prognostic risk model in HCC. Gene expression and corresponding clinical data were searched from the Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC) portal. From the TCGA database, by unsupervised clustering method, we determined three FAM clusters and two gene clusters with distinct clinicopathological and immune characteristics. Based on 79 prognostic genes identified from 190 differentially expressed genes (DEGs) among three FAM clusters, five prognostic DEGs (CCDC112, TRNP1, CFL1, CYB5D2, and SLC22A1) were determined to construct risk model by least absolute shrinkage and selection operator (LASSO) and multivariate cox regression analysis. Furthermore, the ICGC dataset was used to validate the model. In conclusion, the prognostic risk model constructed in this study exhibited excellent indicator performance of overall survival, clinical feature, and immune cell infiltration, which has the potential to be an effective biomarker for HCC immunotherapy.

"Guide" of muscone modification enhanced brain-targeting efficacy and anti-glioma effect of lactoferrin modified DTX liposomes

Glioma is one of the most aggressive malignant diseases for human health. It is difficult to resect completely due to their invasiveness. The targeted delivery, as a noninvasive approach, is a major strategy for the development of treatments for brain tumors. Lactoferrin (Lf) receptors are over-expressed in both brain endothelial cells and glioma cells. Macromolecular Lf modified nanoparticles have been shown to enhance the brain targeting. Muscone is a "guide" drug that have been demonstrated to promote liposomes into the brain by modification. To further enhance the brain-targeting efficacy of Lf modified carriers, we designed that Lf and muscone dual-modified liposomes cross blood-brain barrier (BBB) and target to brain for enhanced docetaxel (DTX) brain delivery. The results showed that we successfully prepared Lf and muscone dual-modified liposomes (Lf-LP-Mu-DTX), the number of Lf molecules connected to the surface of per liposome was 28. Lf-LP-Mu-DTX increased uptake in both U87-MG cells and hCMEC/D3 cells, enhanced penetration of U87-MG tumor spheroid and in vitro BBB model, had better in vitro and in vivo anti-tumor effects. In conclusion, "guide" of muscone modification enhanced brain-targeting efficacy of Lf modified liposomes, Lf and muscone dual-modified docetaxel loaded liposomes present a potential brain-targeting drug delivery system for use in the future treatment of gliomas.

[Correlation between polycyclic aromatic hydrocarbons component phenanthrene and clinical indicators in patients on peritoneal dialysis]

Objective: To explore the correlation between polycyclic aromatic hydrocarbons (PAHs) component phenanthrene and clinical indicators in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods: A total of 22 patients who underwent peritoneal dialysis catheterization and regular dialysis in the First Affiliated Hospital of Zhengzhou University from June to August 2018 were selected. Meanwhile, 18 healthy adults who underwent physical examination were also selected as the control group. Fasting blood samples were taken to detect the concentration of PAHs components for comparison, and the correlation between PAHs components and clinical indicators was further analyzed. Results: There were 22 cases in CAPD group (13 males and 9 females), and aged (45±13) years, while there were 18 cases in control group (6 males and 12 females), and aged (41±13) years. The concentration of blood phenanthrene (PHE) was the highest in CAPD group [0.449 (0.254, 0.581) mg/L], and it was only lower than acenaphthene in the control group [0.081 (0.050, 0.444) mg/L], with a statistically significant difference between the two groups (P=0.008). The analysis of PHE and clinical indicators showed that the concentration of PHE in CAPD patients was negatively correlated with weekly urea clearance index (Kt/V), weekly creatinine clearance (Ccr) and leukocyte level, but positively correlated with triglyceride level (r=-0.743, -0.749, -0.655 and 0.610, respectively, all P<0.05). Simple linear regression analysis demonstrated that for every 0.1 mg/L increase in PHE concentration, weekly Kt/V, weekly Ccr and white blood cell count decreased by 0.226, 3.050 L/1.73 m² and 0.512×10⁹/L, respectively, but triglyceride level increased by 0.152 mmol/L (all P<0.05). Multiple linear regression analysis revealed that the blood PHE concentration of CAPD patients was negatively correlated with weekly Kt/V and Ccr levels (t=-2.402 and -2.368, respectively, both P<0.05). All CAPD patients were followed up for 3 years, during which 8 patients (36.4%) withdrew from peritoneal dialysis due to technical failure, and the baseline PHE concentration was higher than that of patients who did not quit peritoneal dialysis [0.572 (0.416, 0.662) vs 0.268 (0.120, 0.475) mg/L, P=0.003]. Eight patients (36.4%) had cardiovascular events, and the baseline blood PHE concentration was higher than that of patients without cardiovascular events [0.542 (0.389, 0.741) vs 0.373 (0.157, 0.545) mg/L, P=0.045]. Conclusion: PHE correlates with clinical indicators of CAPD patients, including Kt/v, Ccr, leukocyte and triglyceride.

[Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study]

OBJECTIVE

To explore and analyze the relationship between early onset of puberty and different types of obesity in children, by combining large sample cross-sectional survey data with long-term longitudinal cohort data, so as to provide clues for further clarifying the health hazards of early onset of puberty and obesity prevention and control.

METHODS

The research data were from the cross-sectional survey data of seven provinces(autonomous regions, municipalities) in China and the cohort data of adolescent development in Xiamen. The study first found the association between early onset of puberty and obesity by Logistic regression on the cross-sectional data, and then used Poisson regression to analyze the association between early puberty initiation and various types of obesity risk.

RESULTS

In the study, 43 137 and 1 266 children were included in the cross-sectional survey and cohort survey respectively. The cross-sectional study found that among the girls aged 10-13 years, compared with the girls of the same age who did not start puberty, the body mass index (BMI)-Z score of the girls in the puberty start group was 0.5-0.8 higher, and the waist circumference Z score was 0.4-0.7 higher, and the risk of various types of obesity was higher. At the same time, the early onset of puberty was positively correlated with simple obesity, central obesity and compound obesity, the OR (95%CI) were 1.86 (1.42-2.44), 1.95 (1.65-2.32) and 1.86 (1.41-2.45), respectively. No significant association was found in boys. According to the cohort data, in girls, the risk of simple obesity was 6.00 times [RR (95%CI): 6.00 (1.07-33.60)], the risk of central obesity was 3.30 times [RR (95%CI): 3.30 (1.22-8.92)], and the risk of compound obesity was 5.76 times [RR (95%CI): 5.76 (1.03-32.30)], compared with the group without early puberty initiation, while no association between early puberty initiation and obesity was found in boys.

CONCLUSION

Based on the cross-sectional survey and longitudinal cohort survey, it is confirmed that the early onset of puberty in girls may increase the risk of simple obesity, central obesity and compound obesity, while there is no significant correlation between puberty onset and obesity in boys.

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Disclosure of Interests

None declared

POS0720 LOW-DOSE GLUCOCORTICOIDS WITHDRAWN IN SYSTEMIC LUPUS ERYTHEMATOSUS: A DESIRABLE AND ATTAINABLE GOAL

Background

Prolonged use of GC may cause irreversible organ damage, leading to impaired quality of life and even increased mortality. However, many physicians are worried about severe flares after GC withdrawal in daily practice.

Objectives

To assess the risk of flare in systemic lupus erythematosus (SLE) patients after low dose glucocorticoids (GC) discontinuation and evaluate the risk factors of flare.

Methods

SLE patients who ever discontinued GC were identified from PKUFHS cohort. The disease flare profile after GC discontinuation were analyzed. Flare rate was analyzed using Kaplan-Meier analysis. COX regression was used to determine the effect of variables on SLE flare. A prognostic nomogram using Cox proportional hazards regression modeling were developed.

Results

132 SLE patients were eligible for the final analysis. They were followed up for a median (IQR) period of 21.8 (9.01, 36.7) months. The cumulative probability of flare after GC discontinuation was 8.3 % at 6 months, 16.8% at year 1 and 27.5% at year 2 (Figure 1A). In multivariate COX analysis, hypocomplementemia and serologically active clinically quiescent (SACQ) were independent risk factors of flare [HR 2.53, 95% CI (1.32, 4.88); HR 3.17, 95% CI (1.44, 6.97), respectively]. Age ≥ 40y at GC withdrawal and hydroxychloroquine usage were independent protective factors of flare [HR 0.53, 95% CI (0.29, 0.99); HR 0.32, 95% CI (0.17, 0.62), respectively] (Table 1). The protective effect of hydroxychloroquine was dosage related. From the prospective of different tapering strategies embodied as duration from prednisone 5mg/d to complete discontinuation, slower tapering strategy (12-24 months) significantly reduced the risk of flare compared to faster tapering strategy (< 3 months) [HR 0.30, 95% CI (0.11, 0.82), p=0.019]. The prognostic nomogram including aforementioned factors effectively predicted 1- and 2-year probability of flare-free (Figure 1B).

Table 1.

Predictors of flare by univariate and multivariate COX analysis.

UnivariatepMultivariatepMultivariatepModel 1Model 2age≥40y at GC withdrawal0.59 (0.33,1.07)0.0840.53 (0.29, 0.99)0.0490.63 (0.33, 1.18)0.147Age at onset ≥18y2.03 (0.62, 6.66)0.2442.75 (0.77, 9.85)0.1212.88 (0.81, 10.2)0.103Remission duration≥60 months since the last flare0.66 (0.35, 1.27)0.2170.81 (0.41, 1.57)0.5260.73 (0.38, 1.41)0.346history of thrombocytopenia1.73 (0.94, 3.18)0.0771.36 (0.70, 2.65)0.3591.45 (0.74, 2.83)0.278history of lupus nephritis0.86 (0.47, 1.55)0.610////Hypocomplementemia1.97 (1.06, 3.66)0.0312.53 (1.32, 4.88)0.005//anti-dsDNA positive1.25 (0.70, 2.23)0.456////SACQ (both)2.91 (1.38, 6.15)0.005//3.17 (1.44, 6.97)0.004SACQ (or)1.29 (0.73, 2.30)0.380////Hydroxychloroquine or not0.29 (0.16, 0.53)<0.0010.29 (0.15, 0.56)<0.0010.32 (0.17, 0.62)0.001Immunosuppressant or not0.77 (0.40, 1.48)0.426////

There was strong collinearity between hypocomplementemia and SACQ, so the two parameters were separated into two models. SACQ (both): anti-dsDNA positive and hypocomplementemia; SACQ (or): anti-dsDNA positive or hypocomplementemia; GC: glucocorticoids. Data were shown as HR (95% CI).

Figure 1.

Conclusion

Low-dose GC is feasibly discontinued with infrequent flare in real-life setting. SACQ and younger age are potential risk factors of SLE flare, while hydroxychloroquine usage and slow GC tapering to withdrawal can reduce relapse. The visualized model we developed may help to predict risk of flare among SLE patients who discontinued GC.

Disclosure of Interests

None declared

AB0030 THE BIOLOGICAL FUNCTION AND MECHANISM EXPLORATION OF TACI IN SJOGREN’S SYNDROME

Background

primary Sjogren’s syndrome (pSS) is a chronic autoimmune disease that affects the lacrimal, salivary and other exocrine glands. More and more studies have shown that B cells play a central role in the pathogenesis of SS.

Objectives

We intended to explore the expression of the transmembrane activator, calcium modulator and cyclophilin ligand interactor (TACI) on the B cells, its role in pSS, and possible signal transduction pathways.

Methods

We included 34 naive pSS patients who visited the rheumatology department of Peking University First Hospital, and 37 gender- and age-distribution matched healthy controls (HCs). (1) To compare the B cell subsets, expression of TACI and relevant receptors in pSS patients, peripheral blood mononuclear cells were separated to analyze the ratio of B subsets, TACI, and BAFF-R by flow cytometry; ELISA was applied to detect the serum BAFF and soluble TACI (sTACI) concentration. (2) As for functional research of TACI, CD19+ B cells separated by magnetic sorting were treated under in vitro culture circumstances with raw TACI, TACI knocked down by siRNA, and sTACI analog (telitacicept) intervention with varing doses. The apoptosis, proliferation, differentiation and regulatory capacity on T cells were analyzed by flow cytometry, inflammatory cytokines and immunoglobulin levels in the culture supernatants were detected by CBA. (3) As for TACI-associated signaling pathway exploration, based on our previous miRNA data and relevant report of high quality, miRNA associated with TACI with significantly biased expression was confirmed by RT-qPCR. Screening the target gene of the candidate miRNA, and miRNA overexpression and inhibition experiments were conducted to validate the targeted relationship in B cells. And TACI-associated signaling pathway was explored via overexpressing and inhibiting the target gene.

Results

(1) Compared to HC, peripheral blood B subsets of pSS patients exhibited a significant bias, manifesting as increased proportion of CD19+CD24hiCD38hi Breg and decreased ratio of CD19+CD24+CD38- memory B cells. The expression of TACI in all B subsets was down-regulated, while that of BAFF-R was up-regulated. Both the serum concentration of BAFF and sTACI in pSS patients increased significantly. (2) As for functional research of TACI, in the setting of raw TACI, B cells in the pSS group showed higher apoptosis rate than HC under culture in vitro, where the ligand of TACI (APRIL or BAFF) addition turned the rate comparable; more active proliferation, and impaired capacity of inducing Treg cells to secrete IL-10. When TACI was knocked down by 50%, B cells performed less late apoptosis, significantly increased proliferation, impaired differentiation, significant dysfunction of Breg itself and impaired induction of Treg cells to secrete IL-10. While telitacicept intervention increased early apoptosis rate of B cells, significantly inhibited proliferation in 500ng/mL group and impaired ability of Breg and Treg cells to secrete IL-10. Besides, increased TACI on B cells treated with telitacicept, decreased IgG and increased IgA in the culture supernatants were observed. (3) As for TACI-associated signaling pathway exploration, hsa-miR-30b-5p showed satisfactory correlation between both transmembrane and sTACI. Besides, the expression of hsa-miR-30b-5p was significantly down-regulated, and inhibition its expression in vitro could lead to differentiation retard, impaired secretion of IL-10 by Breg cells. SMAD1 was screened based on database and validated as its target gene by overexpressing and inhibiting hsa-miR-30b-5p in B cell. After targeted up- or down-regulating the transcription of SMAD1 further, the transcription of ID2 downstream the TGF-β/Hippo signaling pathway changed accordingly.

Conclusion

The expression of TACI on peripheral blood B cells was deficient in pSS patients. TACI deficiency was closely associated with the downregulation of hsa-miR-30b-5p, activating TGF-β/Hippo pathway mediated by its target gene SMAD1 and taking part in the pathogenesis of pSS.

Disclosure of Interests

None declared

The association of maternal vaginal bleeding and progesterone supplementation in early pregnancy with offspring outcomes: a prospective cohort study

Background

Progesterone is widely used to improve the adverse pregnancy outcomes related to vaginal bleeding during early pregnancy. However, the evidence of its effectiveness is equivocal.

Methods

Six thousand six hundred fifteen mother-infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on vaginal bleeding, progesterone administration in early pregnancy were obtained at enrolment. Birth outcomes were obtained from the hospital notes. Body weight of the infants at 12 months of age was collected by telephone interview. Multivariable logistic regression was conducted to estimate the effect of vaginal bleeding and progesterone administration in early pregnancy on birth outcomes and weight status of infants at 12 months of age.

Results

21.4% (1418/6615) participants experienced bleeding in early pregnancy, and 47.5% (674/1418) of them were treated with progesterone. There were no significant associations between progesterone supplementation in early pregnancy and offspring outcomes. Compared to women without bleeding or any therapy, women with bleeding and progesterone therapy experienced increased risk of preterm (OR 1.74, 95% CI 1.21–2.52), and delivering a small-for-gestational-age (SGA) (OR 1.46, 95% CI 1.07–1.98) or low birth weight (LBW) (OR 2.10, 95% CI 1.25–3.51) neonate, and offspring of them had an increased risk of weight for age z-score (WAZ) < -1 at 12 months of age (OR 1.79, 95%CI 1.01–3.19).

Conclusions

Offspring of mothers with bleeding and progesterone therapy were more likely to be a premature, SGA or LBW neonate, and had lower weight at 12 months of age. Progesterone supplementation may have no beneficial effect on improving adverse offspring outcomes related to early vaginal bleeding.

Trial registration

TMCHC was registered at clinicaltrials.gov as NCT03099837 on 4 April 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04711-1.

Increased food diversity in the first year of life is inversely associated with allergic outcomes in the second year

BACKGROUND

The evidence on the relationship between diet diversity in early life and allergic outcomes was few and inconsistent. We sought to determine the association of food diversity in the first year of life with allergic outcomes in the second year.

METHODS

Two thousand two hundred fifty-one mother-infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on complementary foods introduction was obtained by telephone interview at 6- and 12-month postpartum follow-up. Any doctor-diagnosed allergic diseases in the second year were recorded at 2-year postpartum follow-up. Food allergies in infancy were assessed and self-reported by mothers at each postpartum follow-up. Multivariable logistic regression was used to examine the effect of food diversity at 6 and 12 months of age on later allergic diseases and food allergy.

RESULTS

A total of 135 (6.0%) infants reported allergic diseases at between 1 and 2 years of age. Independent of food allergy history of infants and other potential confounders, less food diversity at 6 months of age was associated with increased risk of later allergic diseases (OR 2.17, 95% CI 1.04-4.50 for 0 vs. 3-6 food groups). By 12 months of age, significant inverse associations with later allergic diseases (OR 2.35, 95% CI 1.03-5.32 for 1-5 vs. 8-11 food groups, and OR 1.98, 95% CI 1.16-3.37 for 6-7 vs. 8-11 food groups) and food allergy (OR 2.10, 95% CI 1.29-3.42 for 1-5 vs. 8-11 food groups) were observed. Children with higher food diversity in both periods had the lowest risk of allergic diseases during the second year of life.

CONCLUSIONS

A more diverse diet within the first year of life was associated with reduced risk of allergic diseases at 1-2 years of age. Introducing higher diversity of foods from 6 to 12 months of age might be an effective strategy to improve the allergy outcomes of infants in later life.

Combined integrin αvβ3 and lactoferrin receptor targeted docetaxel liposomes enhance the brain targeting effect and anti-glioma effect

The integrin α_vβ₃ receptor and Lactoferrin receptor (LfR) are over-expressed in both cerebral microvascular endothelial cells and glioma cells. RGD tripeptide and Lf can specifically bind with integrin α_vβ₃ receptor and LfR, respectively. In our study, RGD and Lf dual-modified liposomes loaded with docetaxel (DTX) were designed to enhance the brain targeting effect and treatment of glioma. Our in vitro studies have shown that RGD-Lf-LP can significantly enhance the cellular uptake of U87 MG cells and human cerebral microvascular endothelial cells (hCMEC/D3) when compared to RGD modified liposomes (RGD-LP) and Lf modified liposomes (Lf-LP). Free RGD and Lf competitively reduced the cellular uptake of RGD-Lf-LP, in particular, free RGD played a main inhibitory effect on cellular uptake of RGD-Lf-LP in U87 MG cells, yet free Lf played a main inhibitory effect on cellular uptake of RGD-Lf-LP in hCMEC/D3 cells. RGD-Lf-LP can also significantly increase penetration of U87 MG tumor spheroids, and RGD modification plays a dominating role on promoting the penetration of U87 MG tumor spheroids. The results of in vitro BBB model were shown that RGD-Lf-LP-C6 obviously increased the transport of hCMEC/D3 cell monolayers, and Lf modification plays a dominating role on increasing the transport of hCMEC/D3 cell monolayers. In vivo imaging proved that RGD-Lf-LP shows stronger targeting effects for brain orthotopic gliomas than that of RGD-LP and Lf-LP. The result of tissue distribution confirmed that RGD-LF-LP-DTX could significantly increase brain targeting after intravenous injection. Furthermore, RGD-LF-LP-DTX (a dose of 5 mg kg⁻¹ DTX) could significantly prolong the survival time of orthotopic glioma-bearing mice. In summary, RGD and LF dual modification are good combination for brain targeting delivery, RGD-Lf-LP-DTX could enhance brain targeting effects, and is thus a promising chemotherapeutic drug delivery system for treatment of glioma.

[The impact of occupational aluminum exposure on workers' overall cognitive function and various cognitive fields]

Objective: To evaluate the effects of occupational aluminum exposure on workers' overall cognitive function and cognitive fields. Methods: From July to August 2019, using the method of cluster sampling, 101 and 117 workers were selected from the electrolytic aluminum workshop of an aluminum plant in a region and the maintenance workshop of a plant in the same region. The venous blood of the subjects was collected, the plasma was extracted, and the blood aluminum concentration was measured by ICP-MS. According to the blood aluminum concentration and type of work, 93 workers who were lower than the median blood aluminum concentration and in the maintenance workshop of a factory were divided into low aluminum exposure group, and 85 workers who were higher than the median blood aluminum concentration and in the electrolytic aluminum workshop of an aluminum factory were divided into high aluminum exposure group. The basic information of the respondents, was collected through the employee physical examination form. The overall cognitive function of workers was evaluated by Beijing Montreal Cognitive Assessment Scale (MoCA) . Multiple linear regression analysis and logistic regression analysis were used for multiple statistical analysis. Results: Compared with the low aluminum exposure group (25.42±1.808) , the total score of MoCA in the high aluminum exposure group (23.84±2.919) was significantly lower, and the scores of visual space, executive function, abstract and delayed recall were significantly lower (P<0.05) . Linear regression analysis showed that the total score of MoCA, visual space and executive function, naming and delayed recall were negatively correlated with blood aluminum concentration (β=-0.018、-0.008、-0.003、-0.008, P<0.05) .MOCA total score, visual space and executive function, attention, language, abstraction, orientation were positively correlated with educational level (β=0.853、0.310、0.216、0.171、0.412、0.122, P<0.05) . Logistic regression analysis showed that adjusting for age, smoking, drinking and education, blood aluminum was a risk factor for mild cognitive impairment (OR=1.017, P<0.05) ; Education level was the protective factor of mild cognitive impairment (OR=0.419, P<0.05) . Conclusion: Occupational aluminum exposure can affect the overall cognitive function of workers, and occupational aluminum exposure increases the risk of MCI.

[Application of traction metal clip with fishhook-like device in endoscopic resection]

From July 2020 to June 2021, patients in Jiangyin Hospital Affiliated to Nantong University who met the enrollment criteria were treated with the fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a "purse-string suture" to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups. The time required for suturing was (7.83±2.41) min in group A and (11.00±3.31) min in group B. The difference was statistically significant (P=0.002). The number of metal clamps used in group A averaged 7.17 pieces/case, and the number of metal clamps used in group B averaged 7.06 pieces/case. The difference was not statistically significant (P>0.05).The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic resection and effectively prevents postoperative adverse events.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

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

Table 1.

Determinants of disease flare by multivariate Cox regression analyses

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

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

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

Disclosure of Interests:

None declared

POS1481-HPR SEXUAL EXPERIENCE IN MALE PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM A CROSS-SECTIONAL STUDY OF 113 PATIENTS

Background:

The expression and experience of sexuality is a key part of an individual self-identity1, so it is essential for both healthy individuals and patients. Patients with ankylosing spondylitis (AS) may be susceptible to sexual issues due to disease activity, dysfunction and comorbid emotional problems. However, sexuality, especially sexual experience, are rarely paid attention in patients with AS.

Objectives:

Our study aims to assess sexual experience in male patients with AS, and analyze the factors affecting sexual experience.

Methods:

This is a cross-sectional study. A total of 113 patients with AS and 46 healthy people were investigated, matched according to age and body mass index. The Sexual Experience Questionnaire is used to assess male sexual experience. Linear regression analysis is used to explore the contributions of clinical variables to worse sexual experience.

Results:

There is a significant difference in the total sexual experience score between AS patients and healthy controls (41.92±8.83 vs 46.98±8.10, P=0.0013). Also, patients with AS have a worse score in all dimensions of sexual experience, including erectile function, individual satisfaction and couple satisfaction, comparing to healthy people. In the regression model after controlling for the effects of age, disease duration and body mass index, disease activity (BASDAI), function (BASFI), mobility (BASMI, chest expansion and finger-floor distance), health index (ASAS HI), sleep quality (PSQI) and psychological status (HADS, HADS-A and HADS-D) are significant determinants of sexual experience, including erectile function (except for chest expansion), individual satisfaction (except for BASMI) and couple satisfaction (except for BASMI). See Table 1 for details.

Table 1.

Multivariable regression analysis of association between sexual experience and clinical outcomes

IndependentSexual experience total scoreErectile functionIndividual satisfactionCouple satisfactionβ (95%CI)Pβ (95%CI)Pβ (95%CI)Pβ (95%CI)PPain total-0.09 (-0.25, 0.07)0.28-0.27 (-0.58, 0.03)0.073-0.51 (-0.91, -0.100.014-0.15 (-0.32, 0.02)0.077BASDAI1.35 (-2.24, -0.45)0.003-0.42 (-0.75, -0.09)0.014-0.72 (-1.16, -0.28)0.001-0.21 (-0.40, -0.02)0.028BASFI-1.80 (-2.59, -1.01)<0.001-0.62 (-0.91, -0.32)<0.001-0.89 (-1.28, -0.50)<0.001-0.30 (-0.47, -0.13)0.001BASMI-1.04 (-2.01, -0.07)0.036-0.47 (-0.82, -0.12)0.008-0.48 (-0.96, 0.001)0.051-0.09 (-0.29, 0.12)0.413Chest expansion1.60 (0.24, 2.96)0.0210.50 (-0.004, 0.99)0.0520.74 (0.07, 1.42)0.0320.36 (0.08, 0.64)0.011Finger-floor distance-0.20 (-0.33, -0.07)0.003-0.07 (-0.11, -0.02)0.009-0.10 (-0.17, -0.03)0.003-0.04 (-0.06, -0.01)0.011ASAS HI-1.27 (-1.64, -0.91)<0.001-0.42 (-0.55, -0.28)<0.001-0.62 (-0.80, -0.43)<0.001-0.24 (-0.32, -0.16)<0.001PSQI-0.60 (-1.11, -0.09)0.021-0.19 (-0.38, -0.004)0.045-0.28 (-0.54, -0.03)0.03-0.13 (-0.23, -0.02)0.019HADS-0.53 (-0.76, -0.29)<0.001-0.18 (-0.27, -0.09)<0.001-0.24 (-0.36, -0.13)<0.001-0.10 (-0.15, -0.05)<0.001HADS-A-0.86 (-1.30, -0.42)<0.001-0.28 (-0.44, -0.12)0.001-0.42 (-0.63, -0.20)<0.001-0.17 (-0.26, -0.07)<0.001HADS-D-0.99 (-1.45, -0.53)<0.001-0.35 (-0.52, -0.19)<0.001-0.44 (-0.67, -0.21)<0.001-0.20 (-0.29, -0.10)<0.001

Conclusion:

Worse sexual experience is associated with increased disease activity, decreased function, poor mobility, decreased health index, poor sleep quality and psychological status. Therefore, special attention to worse sexual experience in patients with AS is essential to assess disease-related suffering and develop new patient management strategies.

References:

[1]Hill J, Bird H, Thorpe R. Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology (Oxford), 2003. 42(2):280-6.

Disclosure of Interests:

None declared

[Sex Estimation of Typical Adult Vertebrae Morphology in Central China Based on CT Technique]

Abstract

Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/　maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.

Effects of IL-1β and IL-18 induced by NLRP3 inflammasome activation on myocardial reperfusion injury after PCI

OBJECTIVE

To investigate the effect of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in the serum levels of interleukin-1β (IL-1β) and interleukin-18 (IL-18) in patients with myocardial reperfusion injury after the percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

Twenty healthy controls (control group) and forty patients (treatment group) were recruited in this study. The enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of IL-1β and IL-18 at various time points in both the control and treatment groups. Data processing and analysis were performed using the Statistical Product and Service Solution (SPSS) 22.0 software (IBM Corp, Armonk, NY, USA). Pearson's correlation coefficient test was applied in all data analyses. A difference was statistically significant when p<0.05.

RESULTS

The levels of IL-1β and IL-18 in the treatment group were significantly higher than those in the control group (p<0.05). The IL-1β level in the treatment group peaked at 0.5 h after PCI and then, gradually decreased. The multiple regression analysis showed that IL-1β level was positively correlated with levels of LDL-C and IL-18 (p<0.05, r=0.527 and 0.955 respectively), and negatively correlated with the HDL-C level (p<0.05, r=-0.34).

CONCLUSIONS

The levels of IL-1β and IL-18 significantly rose in patients with myocardial ischemia-reperfusion injury after PCI.

Effect of Lonicera japonica extract on lactation performance, antioxidant status, and endocrine and immune function in heat-stressed mid-lactation dairy cows

Here, we examined the effects of Lonicera japonica extract (LJE) on lactation performance, antioxidant status, and endocrine and immune function in heat-stressed mid-lactation dairy cows. Twenty-four healthy Chinese Holstein mid-lactation dairy cows, all with similar milk yield (30.0 ± 1.0 kg/d), parity (2.5 ± 0.3), and days in milk (105 ± 5 d) were allocated to 4 groups using a randomized complete block design: a negative control group (without LJE supplementation; CON) and groups that received LJE at 14, 28, and 56 g/d. The experiment lasted 10 wk over a hot summer, with a pre-feeding period of 2 wk. Cows were exposed to heat stress, as the average temperature-humidity index was greater than 72. The results showed that LJE had no effect on respiration rate; however, it reduced the rectal temperature of dairy cows experiencing heat stress in both a linear and quadratic manner; the lowest (39.03°C) was recorded for the LJE-28 group, lower than the CON group. Supplementation with LJE did not affect dry matter intake, milk yield, or milk composition. The majority of biochemical parameters in serum were unaffected by supplementation with different amounts of LJE; the exception was creatinine, which was reduced quadratically. Compared with the CON group, serum triiodothyronine concentrations increased significantly in the LJE-28 group. Addition of LJE to the diet increased thyroxine concentrations quadratically; values peaked at 18.62 ng/mL in the LJE-28 group. Furthermore, supplementation with increasing amounts of LJE quadratically increased the activity of glutathione peroxidase and total antioxidant capacity in serum but decreased concentration of malondialdehyde. Although we detected no differences in the concentrations of IgA, IgM, or cytokines, dairy cows in the LJE-28 group had higher IgG and IL-4 concentrations than did cows in the CON group. Supplementation with LJE increased concentrations of IgG and IL-4 in the serum quadratically but decreased that of IL-2. Finally, heat shock protein 72 concentrations in the serum tended to fall quadratically as the amount of LJE increased. In summary, LJE had no negative effects on lactation performance but helped to alleviate heat stress by improving antioxidant status and promoting endocrine and immune functions. Supplementation with LJE at 28 g/d is recommended for lactating dairy cows experiencing heat stress during hot summers.

[Interpretation for the group standards in guidelines for personal protection against coronavirus disease 2019 for diseases control person]

As an emerging infectious disease, the COVID-19 threatened the safety of personnel in the prevention and control during the COVID-19 pandemic. Beijing Association of Preventive Medicine organizes the Beijing CDC and other organizations drafted the group standard entitled "Guidelines for personal protection against coronavirus disease 2019 for diseases control person (T/BPMA 0002-2020)" , according to years of scientific research on personal protection. Based on the principles of emphasizing the scientific, normative and safe nature, the standard was drafted to put forward the reasonable selection and correct use of personal protective equipment for disease control personnel, as well as the procedures for personal protective equipment. The standard provided a standardized basis for ensuring the safety of disease control personnel in contacting and handling of the new coronary pneumonia outbreaks with high risks.

Folic Acid Supplement Use and Increased Risk of Gestational Hypertension

Current results regarding the effect of folic acid (FA) supplement use on gestational hypertension (GH) and preeclampsia are limited and inconsistent. We aimed to investigate whether FA supplement use was associated with GH and preeclampsia. Participants from the Tongji Maternal and Child Health Cohort with information on periconceptional FA supplement use and diagnosis of GH/preeclampsia were included (n=4853). Robust Poisson regression was used to assess the association of FA supplement use and GH and preeclampsia. Among the 4853 participants in this study, 1161 (23.9%) and 161 (3.3%) women were diagnosed with GH and preeclampsia, respectively. The risk ratio of developing GH was higher in women who used ≥800 µg/d FA supplement from prepregnancy through midpregnancy than nonusers (risk ratio, 1.33 [1.08–1.65]). After adjusting for social-demographic, reproductive, lifestyle factors, family history of hypertension, other supplement use, and gestational weight gain, the adverse association remained significant (risk ratio, 1.32 [1.06–1.64]). Restricting the analysis among women with normal weight, without family history of hypertension, and without gestational diabetes mellitus, the positive FA-GH association still existed. We did not find any significant association between FA supplement use and preeclampsia regardless of adjustment. High-dose (≥800 µg/d) FA supplement use from prepregnancy through midpregnancy was associated with increased risk of GH. Attention should be given to avoid the potential risk of GH due to inappropriate FA supplement use in women who are planning or capable of pregnancy.

[A study on the relationship between insufficient sleep and obesity among children and adolescents in China]

Objective: To analyze the relationship between insufficient sleep and obesity or central obesity in Chinese Han children and adolescents aged 9-18 years. Methods: A total of 172 710 students who participated in the 2014 Chinese National Survey on Students Constitution and Health with complete data of sleep duration and physical examination, were selected as study subjects. Insufficient sleep was defined, according to the amount of sleep for pediatric populations recommended by the American Academy of Sleep Medicine. Obesity and central obesity of children and adolescents were judged by experts from the Group of China Obesity Task Force and Health Industry Standards in China. Differences between groups were compared by using the t test or χ(2) test. Logistic regression method was applied to assess the relationship between insufficient sleep and obesity or central obesity. Results: In 2014, numbers of students with insufficient sleep, obesity and central obesity among Chinese Han children and adolescents aged 9-18 years appeared as 133 410 (77.2%), 11 145 (6.5%), and 12 603 (17.8%), respectively. Among the students with insufficient sleep, 8 358 (6.3%) were with obesity and 12 244 (17.9%) were with central obesity. The prevalence of obesity and central obesity among boys with insufficient sleep was higher than that in girls. Pupils with insufficient sleep showed the highest prevalence of obesity and central obesity. After controlling for potential confounders, the risk of obesity appeared an increase of 14.5% (OR=1.145, 95%CI: 1.092-1.200) and the risk of central obesity increased by 12.7% (OR=1.127, 95%CI: 1.078-1.178) in students with insufficient sleep, when compared with those with adequate sleep. Compared with those whose daily sleep duration was less than 6 hours, the ones who slept 7-10 hours per day showed significantly reduction on the risk of obesity and central obesity in students. Conclusions: Insufficient sleep significantly increase the risk of obesity and central obesity in children and adolescents while adequate sleep of 7-10 hours per day would reduce the risk of obesity and central obesity in students.

AB0148 ANALYSIS OF DIFFERENTIALLY EXPRESSED GENES AND MICRORNAS OF B CELLS IN PRIMARY SJOGREN’S SYNDROME BY RNA SEQUENCING

Background:

Primary Sjogren’s syndrome (pSS) is a chronic autimmune disease mainly characterized by the inflammation of exocrine glands. There two key insights into pSS pathogenesis, which included “IFN signature” and hyperactivity of B cells. mRNA and microRNA (miRNA) are very important to control the gene expression.

Objectives:

In this research, we analyzed the differentially expressed genes (DEG) and miRNA of B cells in pSS patients by RNA-sequencing. And we aim to preliminarily screen out some special miRNAs and target gene loci that may be involved in transcription regulation of B cells of pSS.

Methods:

Peripheral blood samples from 3 pSS patients and 3 age-matched healthy controls (HC) were collected. CD19+B cells were sorted by Magnetic cell sorting method. Total RNA was extracted and cDNA of transcriptome or miRNA analysis were prepared and RNA-sequencing was performed to screen the DEG and miRNA. The GO Terms was used to uncover the biological function of DEGs, and the KEGG pathway enrichment was used to find out the related signal pathway. The mRNA-miRNA conjoint analysis was also performed.

Results:

There were a total of 73 significantly DEGs in B cells of pSS patients compared to HC, including 51 upregulated DEGs (such asIFI44L,IFI44,IFIT1,IFITM1,IFIT3,IFIT2,IRF7,IFI6andISG15)and 22 downregulated DEGs (such asESR2andEGR1). GO Terms and KEGG pathway analyses showed that most of the upregulated DEGs were enriched in IFN signaling and IFN regulatory pathway, and also showed the relationship with microbial infection, such as influenza A virus, hepatitis C virus, measles and herpes simplex virus.

There were five significantly differentially expressed miRNAs, including hsa-miR-4485-3p, hsa-miR-144-5p, hsa-miR-144-3p, hsa-miR-451a, hsa-miR-4732-3p. GO Terms and KEGG pathway analyses showed that most of the target genes which regulated by those miRNAs were enrichment on herpes simplex virus and TGF-β signaling pathway.

DEG and differentially expressed miRNAs conjoint analysis showed that the target DEGs which regulated by those miRNAs participated in cytoskeleton formation and modification of DNA or RNA, such asRASD2,CKAP4,SPARS2L METTL.

Conclusion:

There were 51 upregulated DEGs and 22 downregulated DEGs in B cells of pSS patients. GO Terms and KEGG pathway analyses showed that most of the upregulated DEGs were enriched in IFN related signaling pathway, and also showed the significant relationship with microbial infection.

Conjoint analysis showed that the target DEGs which regulated by differentially expressed miRNAs participated in cytoskeleton formation and modification of DNA or RNA. There maybe more than one regulatory methods lead to DEGs in B cells of pSS patients.

Disclosure of Interests:

None declared

OP0093 FREQUENCIES AND PREDICTORS OF THE LUPUS LOW DISEASE ACTIVITY STATE AND REMISSION IN TREATMENT-NAÏVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS -- A REAL-WORLD COHORT STUDY

Background:

After the introduction of treat-to-target strategy in systemic lupus erythematosus (SLE), Lupus Low Disease Activity State (LLDAS) and definitions of remission in SLE (DORIS) were developed and validated. Several studies had demonstrated that the achievement and maintenance of LLDAS or DORIS was associated with good prognosis.

Objectives:

To evaluate the attainability of LLDAS and DORIS in a treatment-naïve cohort of SLE.

Methods:

LDAS5 was defined as LLDAS with a prednisone dose ≤5 mg/d. There were 4 definitions in DORIS: clinical remission on treatment (RONT), complete RONT, clinical remission off treatment (ROFT) and complete ROFT. The treatment-naïve patients from Peking University First Hospital SLE cohort were enrolled. The time to each state and their annual cumulative probabilities were estimated by Kaplan-Meier approach. The frequencies of patients who achieved each component of LLDAS or DORIS during follow-up were determined.

Results:

A total of 218 treatment-naïve patients were included, with a median follow-up of 4.48 years. Respectively, 190 (87.2%), 160 (73.4%), 148 (67.9%), 94 (43.1%), 23 (10.6%) and 18 (8.3%) patients achieved LLDAS, LLDAS5, clinical RONT, complete RONT, clinical ROFT and complete ROFT at least once during the follow-up time. The median time to LLDAS, LLDAS5, clinical RONT and complete RONT were 1.4, 2.3, 2.6 and 4.7 years, respectively.

Table 1.

Frequencies, time to achieve and annual cumulative probabilities of each state by Kaplan-Meier approach

StatesAchieved patientsNumber (%)Time to achieve(years)Cumulative probabilities of achievement (%)Year 1Year 2Year 3Year 4Year 5LLDAS190 (87.2)1.418.869.786.789.192.6LLDAS5160 (73.4)2.36.940.763.376.082.3Clinical RONT148 (67.9)2.65.536.156.168.876.6Complete RONT94 (43.1)4.74.122.637.545.350.4Clinical ROFT23 (10.6)NA1.42.95.46.710.6Complete ROFT18 (8.3)NA0.92.54.84.88.8Table 2.

Patients who achieved each component of LLDAS or DORIS during follow-up

ComponentsNumber (%)SLEDAI-2K ≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever), and no haemolytic anaemia or gastrointestinal active213 (97.7)Clinical SLEDAI-2K =0210 (96.3)PGA ≤1217 (99.5)PGA <0.5199 (91.3)Serology (anti-dsDNA and complement) negative148 (67.9)Prednisone dose ≤7.5 mg/day201 (92.2)Prednisone dose ≤5 mg/day171 (78.4)No prednisone dose40 (18.3)No prednisone dose and Immunosuppressants32 (14.7)

Conclusion:

Our data confirmed that LLDAS is an attainable early treatment target for SLE. Though with more difficulty, RONT can be achieved in two-thirds of our patients. ROFT may not be an ideal treatment target at present as it is only attained in few patients.

References:

[1]Franklyn, K. et al. Ann Rheum Dis. 2016 Sep;75(9):1615-21.

[2]van Vollenhoven, R. et al. Ann Rheum Dis. 2017 Mar;76(3):554-561.

Disclosure of Interests:

None declared

AB0376 DETERMINANTS AND PROTECTIVE EFFECTS OF A LOW DISEASE ACTIVITY STATE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT

Background:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts.

Objectives:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts. The aim of this study was to investigate the frequency and determinants of achieving LLDAS, and the influence of LLDAS on short term outcomes including disease flare and damage accrual in Chinese lupus patients.

Methods:

The baseline and follow-up data of all consecutive patients in a longitudinal lupus cohort from January 2017 to December 2018 were collected prospectively. SLEDAI-2K, PGA and disease flare were assessed at each follow-up visit, and further compared to the previous routine clinical visits. Irreversible disease damage was captured using the SLICC damage index and the short form (36) health survey for health-related quality of life was completed annually.

Results:

One hundred and forty-nine patients were enrolled, with the median disease duration at recruitment of 2.4 (0.9–8.2) years, and median follow-up of 15.4 (10.1-18.2) months. By the end of the study, 104 (69.8%) patients achieved LLDAS at least once; 59 patients achieved LLDAS for≥50% of observations. Multivariate logistic regression analysis showed that age at disease onset< 30 years (OR=0.05, 95%CI [0.01-0.59], p=0.017), 24-hour urine total protein (UTP) level at recruitment (OR=0.9992, 95%CI [0.9987-0.9998], p=0.007), and C3 level (OR=1.004, 95%CI [1.001-1.008], p=0.024) had independent associations with achieving LLDAS for≥50% of all observations (Table 1). During follow-up, 56 (37.6%) patients experienced disease flare including 14 (9.4%) patients with severe flare. Kaplan-Meier analyses showed significant differences in flare rates according to whether LLDAS was achieved and the percentage follow-up time in LLDAS (Figure 1). Multivariate cox analysis revealed that the percentage time of time in LLDAS was an independent negative determinant of disease flare (HR=0.18, 95% CI [0.07-0.48], p=0.001) (Table 2). There were 16 (15.0%)/107 patients who had damage accrual after one year of follow-up. Multivariate logistic analysis showed a tendency for achieving LLDAS during follow-up being protective for damage accrual (OR=0.27, 95%CI [0.07-1.00], p=0.050).

Conclusion:

In this Chinese early disease cohort, LLDAS was an attainable goal in clinical practice. Age at onset, UTP and C3 level at recruitment influenced achievement of LLDAS. LLDAS was negatively associated with disease flare and damage accrual; this needs to be confirmed by future longer follow-up.

Acknowledgments:

The data in this cohort was collected and recorded using the framework of the lupus low disease activity status (LLDAS) study from the Asia-Pacific Lupus Collaboration (APLC).

Disclosure of Interests:

Yanjie Hao: None declared, Lanlan Ji: None declared, Dai Gao: None declared, Yong Fan: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Consultant of: AstraZeneca, Speakers bureau: AstraZeneca, Mandana Nikpour: None declared, Zhuoli Zhang: None declared

THU0120 OVERLAPPING SJOGREN’S SYNDROME AND ULTRASOUND REMISSION, FUNCTIONAL DISABILITY AND MANAGEMENT IN RHEUMATOID ARTHRITIS PATIENTS: A PROPENSITY SCORE MATCHED REAL-WORLD COHORT FROM 2009 TO 2019

Background:

Rheumatoid arthritis (RA) patients with Sjogren’s syndrome (SS) are often referred to as more severe synovitis.

Objectives:

We intend to clarify the impact of overlapping SS on ultrasound remission, functional ability improvement and clinical decision-making in RA patients in a real-world cohort from 2009 to 2019.

Methods:

The medical records of RA patients in our medical center from 2009 to 2019 were reviewed. Cox proportional hazards models of ultrasound remission and health assessment questionnaire (HAQ) improvement were conducted in both the 1-to-1 nearest propensity score matched (PSM) and unmatched cohorts between those RA patients with SS (RA-SS) and without (RA-noSS) to correct critical confounders. Four kinds of PSM methods were used and the corresponding average treatment effect on the treated (ATT) was calculated to clarify the effect of overlapping SS on distinguishable characteristics or drug prescription in RA patients.

Results:

A total of 1100 RA patients were included in the study, of which 133 (12.1%) overlapped with SS. Among 256 patients consisting of 128 RA-SS and 128 RA-noSS after 1-to-1 nearest PSM, overlapping SS was associated with a 44%, 32% lower probability of reaching ultrasound remission, no-functional disability in RA patients, respectively. More prevalent interstitial lung disease (ILD), leukopenia, hypergammaglobulinemia, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and more hydroxychloroquine (HCQ) usage, less biologic disease-modifying anti-rheumatic drugs (bDMARDs) prescription were confirmed to be correlated with overlapping SS by the robust PSM.

Conclusion:

Overlapping SS is associated with a lower probability of reaching ultrasound remission and functional activity improvement, higher prevalence of ILD, leukopenia and hypergammaglobulinemia in RA patients. Weaker interventions such as HCQ may be the mainstream of clinical decision making.

Table.

Hazard Ratios for Ultrasound Remission/No Functional Disability Associated with Overlapping SS

Unmatched cohortMatched cohortUS remissionNo functional disabilityUS remissionNo functional disabilityUnstratified0.63 (0.51, 0.79)0.60 (0.52, 0.70)0.56 (0.42, 0.74)0.68 (0.55, 0.83)Stratified Gender0.62 (0.50, 0.77)0.63 (0.54, 0.74)0.53 (0.40, 0.71)0.66 (0.54, 0.80) Age0.63 (0.51, 0.78)0.60 (0.52, 0.70)0.54 (0.40, 0.72)0.62 (0.50, 0.76) RF0.64 (0.52, 0.80)0.63 (0.54, 0.73)0.56 (0.42, 0.74)0.68 (0.55, 0.83) ACPA0.63 (0.51, 0.79)0.59 (0.50, 0.68)0.57 (0.43, 0.76)0.63 (0.51, 0.78) Seropositivity0.64 (0.52, 0.80)0.63 (0.54, 0.74)0.59 (0.45, 0.79)0.75 (0.61, 0.92) RA duration0.64 (0.51, 0.79)0.61 (0.52, 0.71)0.58 (0.44, 0.77)0.70 (0.57, 0.86) BLDAS28CRP0.64 (0.51, 0.80)0.62 (0.53, 0.72)0.54 (0.41, 0.72)0.66 (0.54, 0.81)

Values are presented as total and stratified Hazard Ratio (95% CI) for ultrasound remission and no functional disability associated with overlapping SS in RA patients according to gender, age, RF/ACPA status, RA duration and DAS28-CRP at 1stvisit. US remission refers to ultrasound GS<2 and PD=0. Unmatched cohort refers to whole sample (n=1100), matched cohort refers to propensity score matched (PSM) patients (n=256). The values are statistically significant at the level of 0.01.

Disclosure of Interests:

None declared

SAT0060 OVERLAPPING SJOGREN’S SYNDROME REDUCES THE PROBABILITY OF REACHING TARGET IN RHEUMATOID ARTHRITIS PATIENTS: A PROPENSITY SCORE MATCHED REAL-WORLD COHORT FROM 2009 TO 2019

Background:

Overlapping Sjogren’s syndrome (SS) is not uncommon in rheumatoid arthritis (RA), and considered as a probable detrimental factor of RA. But data on the impact of overlapping SS on RA therapeutic response is limited.

Objectives:

Our current study aimed to identify the effect in a real-world cohort from 2009 to 2019.

Methods:

The medical records of RA patients who attended the outpatient department of our medical center from 2009 to 2019 were reviewed, and the disease activity based on DAS28-ESR, DAS28-CRP, SDAI and CDAI at each follow-up point were collected. To correct confounders which may affect the therapeutic response between those RA patients with SS (RA-SS) and without (RA-noSS), we compared both the propensity score-matched and unmatched cohorts using the Cox proportional hazards model.

Results:

Among the 1099 RA patients, 129 (11.7%) overlapped with SS validated by positive anti-SSA or pathological minor salivary gland biopsy (MSGB). After propensity score matching based on their baseline characteristics, 126 of 129 RA-SS and 126 of 970 RA-noSS patients were statistically extracted. Overlapping SS was associated with a 29%, 26%, 18%, 22% lower probability of reaching remission in RA patients based on DAS28-ESR, DAS28-CRP, SDAI, CDAI, respectively, which trend kept true for reaching low disease activity (LDA) either. Although overlapping SS had the most significant impact on ESR (HR 0.69, 95%CI 0.61-0.79), other components assessing RA disease activity were also in jeopardy. When stratified by age, RA duration, RF and ACPA status, baseline DAS28-CRP, the trend remained.

Conclusion:

Overlapping SS is associated with a lower probability of reaching target in RA patients, and should be regarded as one of the poor prognostic factors in the management of RA.

Table

Hazard Ratios for Reaching Remission/Low disease activity and Individual Components in RA patients Associated with Overlapping SS

Unmatched cohort(n=1099)Matched cohort(n=252)Trimmed cohort(n=242)Remission Based on Composite Disease Activity ScoreDAS28-ESR0.68 (0.62, 0.75)0.71 (0.62, 0.82)0.74 (0.64, 0.85)DAS28-CRP0.80 (0.74, 0.87)0.74 (0.66, 0.83)0.74 (0.66, 0.83)SDAI0.82 (0.74, 0.91)0.82 (0.70, 0.94)0.83 (0.72, 0.97)CDAI0.77 (0.70, 0.86)0.78 (0.67, 0.91)0.78 (0.67, 0.91)Boolean0.83 (0.75, 0.92)0.80 (0.69, 0.93)0.82 (0.70, 0.95)Remission/LDA Based on Composite Disease Activity ScoreDAS28-ESR0.76 (0.70, 0.82)0.73 (0.65, 0.82)0.74 (0.66, 0.83)DAS28-CRP0.80 (0.74, 0.86)0.76 (0.68, 0.84)0.75 (0.68, 0.84)SDAI0.79 (0.73, 0.85)0.74 (0.66, 0.82)0.74 (0.66, 0.82)CDAI0.78 (0.73, 0.84)0.74 (0.66, 0.82)0.74 (0.66, 0.82)Individual Components of Disease Activity Score28SJC≤10.83 (0.77, 0.89)0.77 (0.69, 0.85)0.76 (0.68, 0.84)28TJC≤10.81 (0.75, 0.87)0.79 (0.70, 0.88)0.78 (0.70, 0.88)PtGA≤10.81 (0.74, 0.89)0.82 (0.71, 0.94)0.82 (0.72, 0.95)PrGA≤10.81 (0.74, 0.88)0.78 (0.69, 0.88)0.79 (0.70, 0.89)ESR≤ULN0.66 (0.61, 0.73)0.69 (0.61, 0.79)0.74 (0.65, 0.84)CRP≤1mg/dL0.84 (0.78, 0.90)0.76 (0.68, 0.84)0.77 (0.69, 0.85)

Disclosure of Interests:

None declared

THU0247 FREQUENCY AND PREDICTORS OF THE LUPUS LOW DISEASE ACTIVITY STATE IN CHINESE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: AN OBSERVATIONAL COHORT STUDY

Background:

As a consensus-based definition of minimally acceptable disease activity in systemic lupus erythematosus (SLE), Lupus Low Disease Activity State (LLDAS) has been well-validated and widely accepted. However, no data about the time to LLDAS in Asian ethnicity has been reported so far.

Objectives:

To estimate the time to LLDAS and the predictors of time to LLDAS in our prospective observational cohort of Chinese patients with SLE.

Methods:

Patients were from Peking University First Hospital SLE cohort and those having not fulfilled LLDAS at enrolment were included in this study. The time to LLDAS and annual cumulative probabilities of LLDAS achievement were estimated by the Kaplan-Meier approach. The predictors of time to LLDAS were identified by univariate and multivariable Cox proportional hazards.

Results:

A total of 574 patients with SLE were included and 435 (75.8%) of them achieved LLDAS during a median 4.2 years of follow-up. The median time to LLDAS was 19.0 months and the cumulative probabilities at 1, 2, 3, 5 and 10 years were 19.8%, 57.6%, 72.0%, 85.1% and 98.0%, respectively. In multivariable Cox models, older age at disease onset, treatment-naïve and hydroxychloroquine prescription were found to be independent predictors of shorter time to LLDAS, after adjusted by daily prednisone dose, SLE Disease Activity Index 2000 and physician’s global assessment. Finally, we developed a matrix model based on the identified independent predictors to present the time to LLDAS in patients with respective characteristics.

Conclusion:

Our study proved that LLDAS is attainable as an early treatment target for SLE in Chinese patients. The older age at disease onset, treatment-naïve and hydroxychloroquine prescription were independent predictors of shorter time to LLDAS.

References:

[1]Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, Wahono CS, Chen SL, Jin O, Morton S, Hoi A, Huq M, Nikpour M, Morand EF; Asia-Pacific Lupus Collaboration. Ann Rheum Dis. 2016 Sep;75(9):1615-21.

Table 1

Baseline variables associated with LLDAS achievement based on multivariable Cox models

CharacteristicsModel 1Model 2Model 3HR (95% CI)pvalueHR (95% CI)pvalueHR (95% CI)pvalueAge at disease onset, years1.010 (1.003-1.016)0.0051.009 (1.002-1.016)0.0101.010 (1.003-1.017)0.004Treatment-naïve1.346 (1.105-1.641)0.0031.425 (1.161-1.749)0.0011.484 (1.204-1.830)<0.001Nephritis0.776 (0.641-0.939)0.0091.066 (0.820-1.385)0.6340.925 (0.737-1.160)0.498SLEDAI0.968 (0.950-0.987)0.001PGA0.685 (0.551-0.853)0.001Daily prednisone (or equivalent) dose, mg/d1.003 (0.998-1.007)0.2661.005 (0.999-1.010)0.093HCQ1.638 (1.263-2.123)<0.0011.713 (1.318-2.225)<0.0011.664 (1.284-2.157)<0.001

Disclosure of Interests:

None declared

[Features of gut microbiota in patients with idiopathic Parkinson's disease]

Objectives: To investigate whether the fecal microbiome of Parkinson's disease patients differs from that of healthy population and explore the pathogenesis and new treatment of idiopathic Parkinson's disease. Methods: A total of 30 patients diagnosed as idiopathic Parkinson disease (PD group) in Beijing Friendship Hospital between April 2017 and June 2018 were enrolled and 30 healthy controls (NC group) were recruited at the same time.Medical records and score of unified Parkinson's disease rating scale (UPDRS) were collected and fresh fecal samples were obtained and stored in refrigerator (-80℃). The microbial compositions of fecal samples were investigated by 16S rRNA gene sequencing targeting the V3-V4 region. The taxa abundance and microbial composition were tested. Results: There was no difference of age and sex in PD and NC groups. Chao1 and Shannon indexes tended to be higher in PD group, yet failed to reach statistic significance (P=0.115 and 0.052). Relative abundance of gut microbiota differed in each taxonomic category. The relative abundance of Firmicutes in PD group was 53.6%(41.7%-64.8%), while that of Bacteroidetes in NC group was 51.7%(31.7%-65.3%). The ratios of Firmicutes to Bacteroidetes were significantly different between the two groups (1.6(0.9-3.4) vs 0.7(0.5-1.4), P=0.001). In Clostridia, Bacilli and Erysipelotrichia of Firmicutes, the relative abundances of Clostridiales, Christensenellaceae, Peptoclostridium, Lactobacillus and Erysipelatoclostridium were higher in PD group (P=0.024, 0.046, 0.036, 0.022 and 0.037). The relative abundance of Prevotella of Bacteroidales, was lower in PD group, yet failed to reach statistic significance (P=0.121). The relative abundances of Alistipes of Rikenellaceae and Butyricimonas of Marinilabiliales in PD group were significantly higher than those in NC group (P=0.047 and 0.033). The relative abundance of Bifidobacterium of Actinobacteria was significanly higher in PD group when compared with NC group (P=0.009). Despite the relatively low abundance, Akkermansia of Verrucomicrobia was significantly higher in PD group than in NC group (P=0.025). Conclusion: The structures of the fecal microbiota differ significantly between PD patients and healthy controls.

Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study

BACKGROUND

Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices.

OBJECTIVE

We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding.

DESIGN

We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8-16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices.

RESULTS

Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16 kg for underweight and normal weight, 15 kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis.

CONCLUSIONS

This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis.

Association of vitamin D supplementation with respiratory tract infection in infants

Vitamin D deficiency has been reported to be associated with respiratory tract infection (RTI). However, evidence regarding the effects of vitamin D supplementation on susceptibility of infants to RTI is limited. In this prospective birth cohort study, we examined whether vitamin D supplementation reduced RTI risk in 2,244 infants completing the follow‐up from birth to 6 months of age. The outcome endpoint was the first episode of paediatrician‐diagnosed RTI or 6 months of age when no RTI event occurred. Infants receiving vitamin D supplements at a daily dose of 400–600 IU from birth to the outcome endpoint were defined as vitamin D supplementation and divided into four groups according to the average frequency of supplementation: 0, 1–2, 3–4, and 5–7 days/week. We evaluated the relationship between vitamin D supplementation and time to the first episode of RTI with Kaplan–Meier plots. The associations of vitamin D supplementation with infant RTI, lower RTI (LRTI), and RTI‐related hospitalization were assessed using modified Poisson regression. The median time to first RTI episode was 60 days after birth (95% CI [60, 90]) for infants without supplementation and longer than 6 months of age for infants with supplementation (p < .001). We observed inverse trends between supplementation frequency and risk of RTI, LRTI, and RTI‐related hospitalization (p for trend < .001), with the risk ratios in the 5–7 days/week supplementation group of 0.46 (95% CI [0.41, 0.50]), 0.17 (95% CI [0.13, 0.24]), and 0.18 (95% CI [0.12, 0.27]), respectively. These associations were significant and consistent in a subgroup analysis stratified by infant feeding.

Exposure to multiple metals in early pregnancy and gestational diabetes mellitus: A prospective cohort study

BACKGROUND

A growing number of epidemiologic studies have estimated associations between type 2 diabetes mellitus and exposure to metals. However, studies on the associations of internal assessments of metal exposure and gestational diabetes mellitus (GDM) are limited in scope and have inconsistent outcomes.

OBJECTIVES

This investigation aimed to explore the associations between urinary nickel (Ni), arsenic (As), cadmium (Cd), antimony (Sb), cobalt (Co), or vanadium (V) in early pregnancy and the subsequent risk of GDM in Chinese pregnant women.

METHODS

The study population included 2090 women with singleton pregnancy from the Tongji Maternal and Child Health Cohort (TMCHC). Urine samples were collected before 20 gestational weeks, and an oral glucose tolerance test (OGTT) was conducted at 24-28 gestational weeks to diagnose GDM. The concentrations of urinary metals were measured using inductively coupled plasma mass spectrometry (ICP-MS) and were corrected for urinary creatinine. The associations between the risk of GDM and urinary metals were assessed using Poisson regression with a robust error variance with generalized estimating equations (GEE) models and Bayesian kernel machine regression (BKMR).

RESULTS

A total of 241 participants (11.53%) were diagnosed with GDM. Five metals (Ni, As, Sb, Co, and V) were found significantly and positively associated with GDM based on single-metal models. In multiple-metal models, for each unit increase of ln-transformed urinary Ni or Sb, the risk of GDM increased 18% [relative risk (RR):1.18, 95%confidence interval (CI): 1.00, 1.38 or RR: 1.18, 95%CI: 1.00, 1.39, respectively]. The BKMR analysis revealed a statistically significant and positive joint effect of the six metals on the risk of GDM, when the urinary levels of the six metals were all above the 55th percentile, compared to the median levels. The effect of metal Ni was significant when the concentrations of the other metals were all fixed at their 25th percentile, and metal Sb displayed a significant and positive effect when all the other metals were fixed at 25th, 50th, and 75th percentiles.

CONCLUSIONS

To the best of our knowledge, this study is the first to demonstrate that increased concentrations of urinary Ni in early pregnancy are associated with an elevated risk of GDM, either evaluated individually or as a metal mixture. All six metals mixed exposure was positively associated with the risk of GDM, while Sb and Ni were demonstrated more important effects than the other four metals in the mixture.

Multifunctional phototheranostic nanomedicine for cancer imaging and treatment

Cancer, as one of the most life-threatening diseases, shows a high fatality rate around the world. When improving the therapeutic efficacy of conventional cancer treatments, researchers also conduct extensive studies into alternative therapeutic approaches, which are safe, valid, and economical. Phototherapies, including photodynamic therapy (PDT) and photothermal therapy (PTT), are tumor-ablative and function-reserving oncologic interventions, showing strong potential in clinical cancer treatment. During phototherapies, the non-toxic phototherapeutic agents can be activated upon light irradiation to induce cell death without causing much damage to normal tissues. Besides, with the rapid development of nanotechnology in the past decades, phototheranostic nanomedicine also has attracted tremendous interests aiming to continuously refine their performance. Herein, we reviewed the recent progress of phototheranostic nanomedicine for improved cancer therapy. After a brief introduction of the therapeutic principles and related phototherapeutic agents for PDT and PTT, the existing works on developing of phototheranostic nanomedicine by mainly focusing on their categories and applications, particularly on phototherapy-synergized cancer immunotherapy, are comprehensively reviewed. More importantly, a brief conclusion and future challenges of phototheranostic nanomedicine from our point of view are delivered in the last part of this article.

Fluorescence decay route of optical transition calculation for trivalent rare earth ions and its application for Er3+-doped NaYF4 phosphor

A novel route for calculating Judd–Ofelt parameters of rare earth ions in powdered samples was proposed by using the fluorescence decay values.