Pretreatment mortality risk prediction model in patients with polymyositis/dermatomyositis-associated interstitial lung disease

OBJECTIVES

Risk prediction for patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD) is challenging due to heterogeneity in the disease course. We aimed to develop a mortality risk prediction model for PM/DM-ILD.

METHODS

This prognostic study analysed patients with PM/DM-ILD admitted to Nanjing Drum Hospital from 2016 to 2021. The primary outcome was mortality within 1 year. We used a least absolute shrinkage and selection operator (LASSO) logistic regression model to identify predictive laboratory indicators. These indicators were used to create a laboratory risk score, and we developed a mortality risk prediction model by incorporating clinical factors. The evaluation of model performance encompassed discrimination, calibration, clinical utility and practical application for risk prediction and prognosis.

RESULTS

Overall, 418 patients with PM/DM-ILD were enrolled and randomly divided into development (n=282) and validation (n=136) cohorts. LASSO logistic regression identified four optimal features in the development cohort, forming a laboratory risk score: C reactive protein, lactate dehydrogenase, CD3+CD4+ T cell counts and PO2/FiO2. The final prediction model integrated age, arthralgia, anti-melanoma differentiation-associated gene 5 antibody status, high-resolution CT pattern and the laboratory risk score. The prediction model exhibited robust discrimination (area under the receiver operating characteristic: 0.869, 95% CI 0.811 to 0.910), excellent calibration and valuable clinical utility. Patients were categorised into three risk groups with distinct mortality rates. The internal validation, sensitivity analyses and comparative assessments against previous models further confirmed the robustness of the prediction model.

CONCLUSIONS

We developed and validated an evidence-based mortality risk prediction model with simple, readily accessible clinical variables in patients with PM/DM-ILD, which may inform clinical decision-making.

[Colorectal cancer with β-catenin protein expression deficiency: a clinicopathological analysis]

Objective: To investigate the clinicopathological features and molecular characteristics of β-catenin-deficient colorectal cancer. Methods: The clinical, pathological and molecular features of 11 colorectal cancers with β-catenin protein loss diagnosed at the 960th Hospital of People's Liberation Army of China, from January 2012 to November 2022 were analyzed. Results: Among the 11 patients, 3 were males and 8 were females. Their age ranged from 43 to 74 years, with the median age of 59 years. Six were in the left colon and 5 were in the right colon. One of the 11 cases had lymph node metastasis, 10 cases were well and moderately differentiated adenocarcinoma, and 1 was mucinous adenocarcinoma. Eight cases were of TNM stage T4, 2 of T1 stage and 1 of Tis stage. β-catenin protein was not detected using immunohistochemistry. Sanger sequencing revealed the presence of fragment-deletion mutation in exon 3 of CTNNB1 gene, resulting in loss of β-catenin protein expression. Conclusion: β-catenin deficiency is present in a small number of colorectal cancers and may be associated with exon 3 mutations of CTNNB1 gene.

Axonal injury mediated by neuronal p75NTR/TRAF6/JNK pathway contributes to cognitive impairment after repetitive mTBI

Repetitive mild traumatic brain injury (rmTBI) is one of the leading causes of cognitive disorders. The impairment of axonal integrity induced by rmTBI is speculated to underlie the progression of cognitive dysfunction. However, few studies have uncovered the cellular mechanism regulating axonal impairment. In this study, we showed that after rmTBI, the activation of neuronal p75NTR signaling contributes to abnormal axonal morphology and impaired axonal transport, which further leads to cognitive dysfunction in mice. By neuron-specific knockdown of p75NTR or treatment with p75NTR inhibitor LM11A-31, we observed better recovery of axonal integrity and cognitive function after brain trauma. Further analysis revealed that p75NTR relies on its adaptor protein TRAF6 to activate downstream signaling via TAK1 and JNK. Overall, our results provide novel insight into the role of neuronal p75NTR in axonal injury and suggest that p75NTR may be a promising target for cognitive function recovery after rmTBI.

Extracellular volume fraction as a potential predictor to differentiate lung cancer from benign lung lesions with dual-layer detector spectral CT

Background

Extracellular volume (ECV) fraction has been used in cardiovascular diseases, pancreatic fibrosis, and hepatic fibrosis. The diagnostic value of ECV for focal lung lesions remains to be explored. The aim of this study was to evaluate the feasibility of ECV derived from a dual-layer detector computed tomography (DLCT) to differentiate lung cancer (LC) from benign lung lesions (BLLs).

Methods

Retrospectively, 128 consecutive patients with pathologically confirmed LC (n=86) or BLLs (n=42) were included. Conventional computed tomography (CT) characteristics and spectral CT parameters were assessed. All patients' hematocrits were measured to correct contrast volume distributions in blood while calculating ECV. After performing logistic regression analysis, a conventional CT-based model (Model A), DLCT-based model (Model B), combined diagnostic models (Model C), and an ECV-based model (Model D) were developed. The diagnostic effectiveness of each model was examined using the receiver operating characteristic (ROC) curve and their corresponding 95% confidence intervals (CIs). The area under the curve (AUC) of each model was compared using the DeLong test.

Results

Certain conventional CT features (such as lesion size, lobulation, spiculation, pleural indentation, and enlarged lymph nodes) differed significantly between the LC and BLL groups (all P<0.05). Statistical differences were found in the following DLCT parameters (all P<0.05): effective atomic number (Zeff) (non-enhancement), electron density (ED) (non-enhancement), ECV, iodine concentration (IC), and normalized iodine concentration (NIC). Models A, B, C, and D had AUCs of 0.801 [95% confidence interval (CI): 0.721-0.866], 0.805 (95% CI: 0.726-0.870), 0.925 (95% CI: 0.865-0.964), and 0.754 (95% CI: 0.671-0.826), respectively. The AUC of Model D (ECV) showed no significant difference from that of Models A and B (DeLong test, P>0.05).

Conclusions

The ECV derived from DLCT may be a potential new method to differentiate LC from BLLs, broadening the scope of ECV in clinical research.

Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review

OBJECTIVES

Patient safety incidents can impact not only patients and families but also healthcare providers, who may experience negative emotions and symptoms, such as anxiety, guilt, stress, and loss of confidence. To identify and support these "second victims," a screening tool called the Second Victim Experience and Support Tool (SVEST) has been developed. This scoping review aims to map our current knowledge of the SVEST in terms of its scope of use, validation and limitations.

STUDY DESIGN

Scoping review.

METHODS

In accordance with the framework outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, we conducted a literature search in MEDLINE, CINAHL, Cochrane Library, SCOPUS, Embase and PsycINFO databases from database inception up till 1 March 2023.

RESULTS

A total of 31 studies were reviewed. The SVEST has been cross-culturally adapted from English into other languages. The SVEST has been successfully used in different contexts and with various healthcare professionals, including doctors, nurses, allied health professionals, midwives and pharmacists. The tool has been used to assess the impact of second victim experiences and the effectiveness of support interventions in addressing the phenomenon. Validity assessment of translated versions of SVEST in the reviewed studies revealed good content validity in most cases, although some studies did not report clear values for scale-level Content Validity Index. On the whole, SVEST is generally a reliable and valid tool, although further refinements and modifications may improve its validity and reliability.

CONCLUSIONS

The review highlights the significance of SVEST as a crucial resource for healthcare providers and organisations that prioritise well-being and safety in health care. It also underscores the importance of recognising the needs of second victims and offering them appropriate interventions to manage the aftermath of adverse events.

Effects of repetitive transcranial magnetic stimulation and their underlying neural mechanisms evaluated with magnetic resonance imaging-based brain connectivity network analyses

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain modulation and rehabilitation technique used in patients with neuropsychiatric diseases. rTMS can structurally remodel or functionally induce activities of specific cortical regions and has developed to an important therapeutic method in such patients. Magnetic resonance imaging (MRI) provides brain data that can be used as an explanation tool for the neural mechanisms underlying rTMS effects; brain alterations related to different functions or structures may be reflected in changes in the interaction and influence of brain connections within intrinsic specific networks. In this review, we discuss the technical details of rTMS and the biological interpretation of brain networks identified with MRI analyses, comprehensively summarize the neurobiological effects in rTMS-modulated individuals, and elaborate on changes in the brain network in patients with various neuropsychiatric diseases receiving rehabilitation treatment with rTMS. We conclude that brain connectivity network analysis based on MRI can reflect alterations in functional and structural connectivity networks comprising adjacent and separated brain regions related to stimulation sites, thus reflecting the occurrence of intrinsic functional integration and neuroplasticity. Therefore, MRI is a valuable tool for understanding the neural mechanisms of rTMS and practically tailoring treatment plans for patients with neuropsychiatric diseases.

T cell immunotherapy for cervical cancer: challenges and opportunities

Cancer cellular immunotherapy has made inspiring therapeutic effects in clinical practices, which brings new hope for the cure of cervical cancer. CD8+T cells are the effective cytotoxic effector cells against cancer in antitumor immunity, and T cells-based immunotherapy plays a crucial role in cellular immunotherapy. Tumor infiltrated Lymphocytes (TIL), the natural T cells, is approved for cervical cancer immunotherapy, and Engineered T cells therapy also has impressive progress. T cells with natural or engineered tumor antigen binding sites (CAR-T, TCR-T) are expanded in vitro, and re-infused back into the patients to eradicate tumor cells. This review summarizes the preclinical research and clinical applications of T cell-based immunotherapy for cervical cancer, and the challenges for cervical cancer immunotherapy.

Maternal hyperglycemia inhibits pulmonary vasculogenesis during mouse fetal lung development by promoting GβL Ubiquitination-dependent mammalian target of Rapamycin assembly

BACKGROUND

Gestational diabetes mellitus (GDM) is associated with retarded lung development and poor lung health in offspring. Mammalian target of rapamycin (mTOR) is a key regulator of vasculogenesis and angiogenesis. The aim of this study was to investigate the role mTOR plays in pulmonary vasculogenesis during fetal lung development under maternal hyperglycemia.

METHODS

First, GDM was induced via streptozotocin injection in pregnant C57BL/6 mice before the radial alveolar count (RAC) in the fetal lungs was assessed using hematoxylin and eosin staining. The angiogenic ability of the cultured primary mouse fetal lung endothelial cells (MFLECs) was then assessed using the tube formation assay technique, while western blot and real-time polymerase chain reaction were performed to determine the expression of mTOR, regulatory-associated protein of mTOR (Raptor), rapamycin-insensitive companion of mTOR (Rictor), stress-activated protein kinase interacting protein 1 (Sin1), G protein beta subunit-like protein (GβL), Akt, tumor necrosis receptor associated factor-2 (TRAF2), and OTU deubiquitinase 7B (OTUD7B) in both the fetal lung tissues and the cultured MFLECs. Immunoprecipitation assays were conducted to evaluate the status of GβL-ubiquitination and the association between GβL and mTOR, Raptor, Rictor, and Sin1 in the cultured MFLECs.

RESULTS

The GDM fetal lungs exhibited a decreased RAC and reduced expression of von Willebrand factor, CD31, and microvessel density. The high glucose level reduced the tube formation ability in the MFLECs, with the mTOR, p-mTOR, p-Raptor, and TRAF2 expression upregulated and the p-Rictor, p-Sin1, p-Akt, and OTUD7B expression downregulated in both the GDM fetal lungs and the high-glucose-treated MFLECs. Meanwhile, GβL-ubiquitination was upregulated in the high-glucose-treated MFLECs along with an increased GβL/Raptor association and decreased GβL/Rictor and GβL/Sin1 association. Furthermore, TRAF2 knockdown inhibited the high-glucose-induced GβL-ubiquitination and GβL/Raptor association and restored the tube formation ability of the MFLECs.

CONCLUSION

Maternal hyperglycemia inhibits pulmonary vasculogenesis during fetal lung development by promoting GβL-ubiquitination-dependent mTORC1 assembly.

Enhanced photocatalytic activity of Fe-, S- and N-codoped TiO2 for sulfadiazine degradation

The composite material based on N-, S-, and Fe-doped TiO2 (NSFe-TiO2) synthesized by wet impregnation was used as a photocatalyst to rapidly degrade sulfadiazine. The photocatalytic degradation behavior and mechanism of sulfadiazine on NSFe-TiO2 were investigated for revealing the role of degradation under ultraviolet light. The results showed that compared with TiO2, NSFe-TiO2 markedly improved the efficiency in photocatalytic degradation of sulfadiazine: more than 90% of sulfadiazine could be removed within 120 min by NSFe-TiO2 dosage of 20 mg L-1. The process conformed to first-order reaction kinetics model. The parameters such as loaded amount of NSFe-TiO2, solution pH value, humic acid concentration and recycle numbers on removal efficiency were also studied. Compared to neutral and alkaline conditions, acidic condition was not conducive to the photocatalysis. HA, Ca2+, Cu2+ and Zn2+ in the actual water body had mild inhibition on sulfadiazine degradation in UV/NSFe-TiO2 system. Fragments screened by high-resolution mass spectrometry were conducted to explore the oxidation mechanism and pathways of sulfadiazine degradation. On the whole, UV/NSFe-TiO2 photocatalysis has a good effect on sulfadiazine removal.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04771-6.

Association between Sarcopenia and Cognitive Trajectories among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

The relationship between sarcopenia and cognitive function has been extensively studied, but is usually explored at a single time point. We used repeatedly measured cognitive data to examine the relationship between sarcopenia and cognitive trajectories over time among middle-aged and older Chinese adults.

DESIGN

A nationally representative cohort study.

SETTING AND PARTICIPANTS

Data were from three waves (2011, 2013 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8963 participants with complete baseline data (wave 1) and at least two cognitive function tests (waves 1-3) were enrolled in this study.

MEASUREMENTS

Sarcopenia was diagnosed at baseline (wave 1). The wave 1-3 data were used to analyze cognitive trajectories over time by constructing a latent class trajectory model (LCTM). Logistic regression model was used to analyze the association between sarcopenia and cognitive trajectories.

RESULTS

Among 8693 participants, we identified two trajectories of cognitive function development, including a persistent low trajectory (n= 4856, 55.86%) and a persistent high trajectory (n= 3837, 44.14%). Sarcopenia was associated with persistently low cognitive trajectory of global cognitive (OR: 1.248, 95%CI: 1.046-1.490) after adjustment for other covariates. This association was still observed when stratified by age, gender, educational level, marital status, social activity, smoking status and drinking status. Mediation analysis showed that body mass index (BMI) mediated efficacy accounting for 42.32% of the relationship.

CONCLUSIONS

Our study showed two trajectory groups of global cognitive function. Sarcopenia was associated with a persistent low trajectory over time and BMI mediated the relationship between sarcopenia and cognitive trajectories among middle-aged and older Chinese adults.

Case Report: Small intestinal metastatic breast cancer: A case report and literature review

Breast cancer is considered a malignant tumor with the highest incidence among women and is prone to develop distant metastasis. Small intestinal metastasis of breast cancer, however, is relatively rare. This case report describes a 49-year-old Chinese female patient who presented with small intestinal obstruction and was diagnosed with lobular breast cancer with small intestinal and contralateral breast metastasis. Clinical manifestations, clinicopathological features and potential mechanisms of metastasis, along with diagnosis and treatment, are discussed with a review of the relevant literature. Although small intestinal metastasis is rare in breast cancer, we should keep high alert on the possibility of gastrointestinal metastasis when treating lobular breast cancer patients.

Automatic Localization and Identification of Thoracic Diseases from Chest X-rays with Deep Learning

BACKGROUND

There are numerous difficulties in using deep learning to automatically locate and identify diseases in chest X-rays (CXR). The most prevailing two are the lack of labeled data of disease locations and poor model transferability between different datasets. This study aims to tackle these problems.

METHODS

We built a new form of bounding box dataset and developed a two-stage model for disease localization and identification of CXRs based on deep learning. The dataset marks anomalous regions in CXRs but not the corresponding diseases, different from all previous datasets. The advantages of this design are reduced labor of annotation and fewer possible errors associated with image labeling. The two-stage model combines the robustness of the region proposal network, feature pyramid network, and multi-instance learning techniques. We trained and validated our model with the new bounding box dataset and the CheXpert dataset. Then, we tested its classification and localization performance on an external dataset, which is the official split test set of ChestX-ray14.

RESULTS

For classification result, the mean area under the receiver operating characteristic curve (AUC) metrics of our model on the CheXpert validation dataset was 0.912, which was 0.021, superior to the baseline model. The mean AUC of our model on an external testing set was 0.784, whereas the state-of-the-art model got 0.773. The localization results showed comparable performance to the stateof- the-art models.

CONCLUSION

Our model exhibits a good transferability between datasets. The new bounding box dataset is proven to be useful and shows an alternative technique for compiling disease localization datasets.

Prediction model for the pretreatment evaluation of mortality risk in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with interstitial lung disease

Background

Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with interstitial lung disease (anti-MDA5 DM-ILD) is a disease with high mortality. We sought to develop an effective and convenient prediction tool to estimate mortality risk in patients with anti-MDA5 DM-ILD and inform clinical decision-making early.

Methods

This prognostic study included Asian patients with anti-MDA5 DM-ILD hospitalized at the Nanjing Drum Hospital from December 2016 to December 2020. Candidate laboratory indicators were retrospectively collected. Patients hospitalized from 2016 to 2018 were used as the discovery cohort and applied to identify the optimal predictive features using a least absolute shrinkage and selection operator (LASSO) logistic regression model. A risk score was determined based on these features and used to construct the mortality risk prediction model in combination with clinical characteristics. Results were verified in a temporal validation comprising patients treated between 2019 and 2020. The primary outcome was mortality risk within one year. The secondary outcome was overall survival. The prediction model’s performance was assessed in terms of discrimination, calibration, and clinical usefulness.

Results

This study included 127 patients, (72 men [56.7%]; median age, 54 years [interquartile range, 48-63 years], split into discovery (n = 87, 70%) and temporal validation (n=37, 30%) cohorts. Five optimal features were selected by LASSO logistic regression in the discovery cohort (n = 87) and used to construct a risk score, including lymphocyte counts, CD3+CD4+ T-cell counts, cytokeratin 19 fragment (CYFRA21-1), oxygenation index, and anti-Ro52 antibody. The retained predictive variables in the final prediction model were age, Heliotrope, fever, and risk score, and the most predictive factor was the risk score. The prediction model showed good discrimination (AUC: 0.915, 95% CI: 0.846–0.957), good calibration (Hosmer–Lemeshow test, P = 0.506; Brier score, 0.12), and fair clinical usefulness in the discovery cohort. The results were verified among patients in the temporal validation cohort (n = 38). We successfully divided patients into three risk groups with very different mortality rates according to the predictive score in both the discovery and validation cohorts (Cochran-Armitage test for trend, P < 0.001).

Conclusions

We developed and validated a mortality risk prediction tool with good discrimination and calibration for Asian patients with anti-MDA5 DM-ILD. This tool can offer individualized mortality risk estimation and inform clinical decision-making.

Iodine-Rich Nanoadjuvants for CT Imaging–Guided Photodynamic Immunotherapy of Breast Cancer

Immunotherapy, which stimulates the body’s own immune system to kill cancer cells, has shown great promise in the field of cancer therapy. However, the uncontrolled biodistribution of immunotherapeutic drugs may cause severe side effects. Herein, we report an iodine-rich nanoadjuvant (INA) for photo-immunotherapy. INA is prepared by encapsulating a toll-like receptor 7 agonist (R837) and a photosensitizer (phthalocyanine) into an iodine-rich amphiphilic copolymer PEG-PHEMA-I. By virtue of the enhanced permeation and retention (EPR) effect, INA can effectively accumulate into the tumor site. Under light irradiation, photodynamic therapy (PDT) triggered by INA will induce immunogenic cell death (ICD) in the tumor region to trigger the release of immune-associated cytokines. Such a process may further induce the maturation of dendritic cells which will be accelerated by R837, leading to the proliferation of effector T cells for immunotherapy. The photo-immunotherapy mediated by INA shows good anticancer efficacy both in vitro and in vivo. Meanwhile, INA is also a CT contrast agent owing to its high density of iodine, which can successfully illuminate tumors by CT imaging. Thus, our study develops a light-triggered nanoadjuvant for CT imaging–guided enhanced photo-immunotherapy.

Brain morphological alterations and their correlation to tumor differentiation and duration in patients with lung cancer after platinum chemotherapy

Objective

Chemotherapy-related brain impairments and changes can occur in patients with lung cancer after platinum chemotherapy and have a substantial impact on survivors’ quality of life. Therefore, it is necessary to understand the brain neuropathological alterations and response mechanisms to provide a theoretical basis for rehabilitation strategies. This study aimed to investigate the related brain morphological changes and clarified their correlation with clinical and pathological indicators in patients with lung cancer after platinum chemotherapy.

Methods

Overall, 28 patients with chemotherapy, 56 patients without chemotherapy, and 41 healthy controls were categorized in three groups, matched for age, sex, and years of education, and included in the cross-sectional comparison of brain volume and cortical thickness. 14 matched patients before and after chemotherapy were subjected to paired comparison for longitudinal observation of brain morphological changes. Three-dimensional T1-weighted images were acquired from all participants, and quantitative parameters were calculated using the formula of the change from baseline. Correlation analysis was performed to evaluate the relationship between abnormal morphological indices and clinical information of patients.

Results

Brain regions with volume differences among the three groups were mainly distributed in frontal lobe and limbic cortex. Additionally, significant differences in cerebrospinal fluid were observed in most ventricles, and the main brain regions with cortical thickness differences were the gyrus rectus and medial frontal cortex of the frontal lobe, transverse temporal gyrus of the temporal lobe, insular cortex, anterior insula, and posterior insula of the insular cortex. According to the paired comparison, decreased brain volumes in the patients after chemotherapy appeared in some regions of the frontal, parietal, temporal, and occipital lobes; limbic cortex; insular cortex; and lobules VI-X and decreased cortical thickness in the patients after chemotherapy was found in the frontal, temporal, limbic, and insular cortexes. In the correlation analysis, only the differentiation degree of the tumor and duration after chemotherapy were significantly correlated with imaging indices in the abnormal brain regions.

Conclusions

Our findings illustrate the platinum-related brain reactivity morphological alterations which provide more insights into the neuropathological mechanisms of patients with lung cancer after platinum chemotherapy and empirical support for the details of brain injury related to cancer and chemotherapy.

[The application value of plasma heterogeneous nuclear ribonucleoprotein A2/B1, Aβ42 and P-tau in the preoperative diagnosis of mild cognitive dysfunction]

Objective: To explore the application value of plasma heterogeneous nuclear ribonucleoprotein A2/B1(hnRNP A2B1), β-amyloid 42(Aβ₄₂) and phosphorylated tau protein(P-tau) levels in elderly patients in the preoperative diagnosis of mild cognitive impairment(MCI). Methods: A total of 200 patients who underwent elective surgery at Tianjin Third Central Hospital from June 2020 to March 2021were Enrolled, regardless of gender, age 65-80 years old. According to the international MCI working group standards and the European Alzheimer's Disease Federation working group standards, patients were divided into MCI group and control group. There were 58 males and 42 females in each group. The patient's plasma hnRNP A2/B1, Aβ₄₂ and P-tau levels were detected before operation. The sensitivity, specificity and accuracy of the diagnosis of MCI were calculated. The receiver operating characteristic curve were drew to evaluate the diagnostic value of each index. Results: The plasma levels of hnRNP A2/B1, Aβ₄₂ and P-tau in the MCI group were 310.0 (275.1, 344.2), 34.5 (24.9, 42.5), 190.4 (150.4, 301.7) ng/L, respectively, which were significantly higher than those of the control group [272.7 (239.6, 291.5), 18.7 (14.7, 26.6), 140.0 (101.8, 217.5) ng/L]. The differences were statistically significant (all P<0.05). Taking the international MCI working group standard as the gold standard, the sensitivity, specificity and area under the ROC curve (AUC) of plasma hnRNP A2/B1 for predicting MCI were 80%, 61%, and 0.781, respectively. The sensitivity, specificity and AUC of plasma Aβ₄₂ for predicting MCI were 78%, 73%, and 0.744. The sensitivity, specificity, and AUC of P-tau for predicting MCI were 51%, 79%, and 0.675, respectively. The sensitivity, specificity and AUC of hnRNP A2/B1 and Aβ₄₂ in predicting MCI were not statistically significant (all P>0.05), but the sensitivity of both were higher than P-tau (all P<0.001). Compared with P-tau, the AUC of plasma hnRNP A2/B1 was higher when predicting MCI (P<0.05). When the three indicators were combined, the sensitivity was 82%, and the AUC was 0.842, both of which were the highest, but the specificity reduced (71%) (all P<0.05). Conclusions: Plasma hnRNP A2/B1 combined with Aβ₄₂ and P-tau levels can improve the sensitivity and accuracy of MCI diagnosis in elderly MCI patients before surgery, and have the greatest diagnostic efficiency. It has certain application value.

A Bibliometric Analysis of 8271 Publications on Thyroid Nodules From 2000 to 2021

INTRODUCTION

Thyroid nodules (TNs) are a common clinical condition. The probability of thyroid nodules being malignant is 7-15%. However, in recent decades, a number of publications on TNs have not been well summarized and discussed. The aim of this study was to summarize and sort out medical publications on TNs over the past 2 decades using a bibliometric method.

MATERIALS AND METHODS

Medical publications from January 1^st, 2000, to November 1^st, 2021, were searched in the Web of Science Core Collection database using the Medical Subject Heading (MeSH) term "thyroid nodule". Full associated data were downloaded, and detailed information was extracted using the bibliometric analysis platform VOSviewer.

RESULTS

A total of 8271 publications related to TNs from the last 2 decades were found and included in this study. An increasing trend was presented in the annual number of publications. The United States, China and Italy contributed the most publications. Carcinoma, management, ultrasound, and fine-needle aspiration were the most popular subjects in the field of TNs. The topics of the studies could be stratified into four clusters. The first cluster was using ultrasound to evaluate the nodules, including the thyroid imaging reporting and data system (TI-RADS), elastography and benign features. The second cluster was the fine-needle aspiration method, including the Bethesda system, cytology and BRAF mutations. The third cluster was the management of nodules, including radiofrequency and thermal ablation, surgery, and consensus statements. The last cluster was carcinoma, which is correlated with all three clusters described above. The preoperative diagnosis of cytologically indeterminate nodules was particularly highlighted in the top 10 most cited publications in recent years.

CONCLUSION

How to diagnose thyroid nodules as malignant or benign, especially in cytologically indeterminate nodules, is still the most concerning topic in TN research. Although the fine-needle aspiration method and gene-expression classifiers show promising results, there is still a crucial need for translations from fundamental studies to clinical applications.

Cytokeratin 19 fragment is associated with severity and poor prognosis of interstitial lung disease in anti-MDA5 antibody-positive dermatomyositis

OBJECTIVES

In the present study, we aimed to assess the clinical significance of cytokeratin 19 fragment (CYFRA21-1) in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive DM-interstitial lung disease (MDA5-DM-ILD).

METHODS

A total of 73 MDA5-DM-ILD patients were retrospectively analysed in this work. Their clinical characteristics, including clinical manifestations, laboratory findings, peripheral blood lymphocyte subsets and lung function, were compared between patients with acute/subacute interstitial pneumonia (A/SIP) and chronic interstitial pneumonia (CIP). The level of serum CYFRA21-1 was also compared between the above-mentioned two groups of patients, and its association with the clinical features and mortality of MDA5-DM-ILD was also evaluated.

RESULTS

Of the 73 MDA5-DM-ILD patients, 26 patients exhibited the A/SIP pattern. The level of serum CYFRA21-1 was higher in MDA5-DM patients with A/SIP compared with the CIP group (P = 0.009). Lower oxygenation index (OI), CD3+CD4+ T cell counts and percentage of CD3+CD4+ cells were also observed in MDA5-DM patients with A/SIP compared with the CIP group. Higher serum CYFRA21-1, lower OI, and lower zone consolidation were associated with a higher risk of A/SIP in MDA5-DM-ILD. In addition, 38 decedents with MDA5-DM-ILD exhibited a greater level of CYFRA21-1 compared with 35 survivors (P < 0.001). Furthermore, it was a prognostic factor and also associated with a higher mortality rate (log-rank test, P < 0.001).

CONCLUSIONS

CYFRA21-1 could be a useful serum indicator associated with occurrence of A/SIP in MDA5-DM-ILD. Moreover, it was associated with a poor survival in MDA5-DM-ILD patients.

A human-computer collaboration for COVID-19 differentiation: combining a radiomics model with deep learning and human auditing

BACKGROUND

This study aimed to build a radiomics model with deep learning (DL) and human auditing and examine its diagnostic value in differentiating between coronavirus disease 2019 (COVID-19) and community-acquired pneumonia (CAP).

METHODS

Forty-three COVID-19 patients, whose diagnoses had been confirmed with reverse-transcriptase polymerase-chain-reaction (RT-PCR) tests, and 60 CAP patients, whose diagnoses had been confirmed with sputum cultures, were enrolled in this retrospective study. The candidate regions of interest (ROIs) on the computed tomography (CT) images of the 103 patients were determined using a DL-based segmentation model powered by transfer learning. These ROIs were manually audited and corrected by 3 radiologists (with an average of 12 years of experience; range 6-17 years) to check the segmentation acceptance for the radiomics analysis. ROI-derived radiomics features were subsequently extracted to build the classification model and processed using 4 different algorithms (L1 regularization, Lasso, Ridge, and Z test) and 4 classifiers, including the logistic regression (LR), multi-layer perceptron (MLP), support vector machine (SVM), and extreme Gradient Boosting (XGboost). A receiver operating characteristic curve (ROC) analysis was conducted to evaluate the performance of the model.

RESULTS

Quantitative CT measurements derived from human-audited segmentation results showed that COVID-19 patients had significantly decreased numbers of infected lobes compared to patients in the CAP group {median [interquartile range (IQR)]: 4 [3, 4] and 4 [4, 5]; P=0.031}. The infected percentage (%) of the whole lung was significantly more elevated in the CAP group [6.40 (2.77, 11.11)] than the COVID-19 group [1.83 (0.65, 4.42); P<0.001], and the same trend applied to each lobe, except for the superior lobe of the right lung [1.81 (0.09, 5.28) for COVID-19 vs. 1.32 (0.14, 7.02) for CAP; P=0.649]. Additionally, the highest proportion of infected lesions were observed in the CT value range of (-470, -370) Hounsfield units (HU) in the COVID-19 group. Conversely, the CAP group had a value range of (30, 60) HU. Radiomic model using corrected ROIs exhibited the highest area under ROC (AUC) of 0.990 [95% confidence interval (CI): 0.962-1.000] using Lasso for feature selection and MLP for classification.

CONCLUSIONS

The proposed radiomics model based on human-audited segmentation made accurate differential diagnoses of COVID-19 and CAP. The quantification of CT measurements derived from DL could potentially be used as effective biomarkers in current clinical practice.

A musculoskeletal ultrasound program as an intervention to improve disease modifying anti-rheumatic drugs adherence in rheumatoid arthritis: a randomized controlled trial

Objectives: To evaluate the effect of a musculoskeletal ultrasound programme (MUSP) applying real-time ultrasonography with reinforcement of findings by a rheumatologist on improving disease-modifying anti-rheumatic drugs (DMARDs) adherence in rheumatoid arthritis (RA).Method: Eligible RA patients with low adherence score (< 6) on the 8-item Morisky Medication Adherence Scale (MMAS-8) were randomized to either an intervention group (receiving MUSP at baseline) or a control group (no MUSP), and followed up for 6 months. Adherence measures (patient-reported and pharmacy dispensing records) and clinical efficacy data were collected. The MUSP's feasibility and acceptability were assessed.Results: Among 132 recruited RA patients, six without baseline visits were excluded; therefore, 126 patients were analysed (62 intervention and 64 control). The primary outcome (proportion of patients with 1 month MMAS-8 score < 6) was significantly smaller (p = 0.019) in the intervention (35.48%) than the control group (56.25%). However, 3 and 6 month adherence and clinical efficacy outcomes were not significantly different between the two groups (all p > 0.05). All 62 patients completed the MUSP (mean time taken, 9.2 min), with the majority reporting moderately/very much improved understanding of their joint condition (71%) and the importance of regularly taking their RA medication(s) (79%). Most patients (90.3%) would recommend the MUSP to another RA patient.Conclusions: The MUSP improved RA patients' DMARDs adherence in the short term and was feasible and well accepted by patients. Future studies could evaluate whether repeated feedback using MUSP could help to sustain the improvement in DMARD adherence in RA patients, and whether this may be clinically impactful and cost-effective.

POS1411 EARLY IDENTIFICATION OF AXIAL SPONDYLOARTHRITIS IN A MULTI-ETHNIC ASIAN POPULATION

Background:

To facilitate earlier diagnosis of spondyloarthritis (SpA), we have previously cross-culturally adapted a self-administered screening questionnaire.

Objectives:

We aimed to improve the sensitivity of this questionnaire as a screening tool by comparing various scoring methods.

Methods:

Subjects newly referred to a rheumatology clinic self-administered the questionnaire before seeing a rheumatologist. Identification of axial SpA by the questionnaire using original scoring (Method A) and scoring based on Assessment of SpondyloArthritis International Society (ASAS) inflammatory back pain (IBP) criteria (Method B), ASAS referral criteria (Method C), ASAS classification criteria (Method D) and a combination of ASAS referral and classification criteria (Method E) were compared to classification by the ASAS classification criteria and diagnosis by rheumatologist. Since Methods B-E were based on SpA features, we compared self-reported vs rheumatologist-documented features in subjects with axial SpA.

Results:

Of 1418 subjects (age: 54 ± 14 years, female: 73%), 39 were classified as axial SpA cases by classification criteria. Methods A-E yielded sensitivities of 39%, 72%, 67%, 49% and 85%, respectively, among patients newly referred to the rheumatology clinic (Table 1). Rheumatologist-documented clinical SpA features exceeded self-report for IBP (62 vs 44%) and uveitis (15 vs 5%). The reverse was true for arthritis (21 vs 80%), enthesitis (28 vs 33%), dactylitis (3 vs 18%), good response to NSAIDs (33 vs 41%) and family history for SpA (5 vs 10%).

Table 1.

Performance of the five scoring methods for the cross-culturally adapted Hamilton axial SpA questionnaire.

Scoring methodSensitivity(95% confidence interval)Specificity(95% confidence interval)Positive predictive value(95% confidence interval)Negative predictive value(95% confidence interval)Method A38.5(23.4 – 55.4)93.7(92.3 – 94.9)14.7(8.5 – 23.1)98.2(97.3 – 98.8)Method B71.8(55.1 – 85.0)73.1(70.7 – 75.4)7.0(4.7 – 10.0)98.9(98.1 – 99.5)Method C66.7(49.8 – 80.9)77.8(75.5 – 80.0)7.8(5.2 – 11.3)98.8(98.0 – 99.4)Method D48.7(32.4 – 65.2)74.9(72.5 – 77.2)5.2(3.2 – 8.0)98.1(97.1 – 98.8)Method E84.6(69.5 – 94.1)37.2(34.6 – 39.8)3.7(2.5 – 5.1)98.8(97.5 – 99.6)

Method A: the original scoring defined by the questionnaire developers; Method B: a scoring based on the ASAS IBP criteria; Method C: a scoring based on the ASAS referral criteria; Method D: a scoring based on the ASAS classification criteria for axial and peripheral SpA; Method E: a scoring based on a combination of the ASAS referral and classification criteria.

Conclusion:

A self-administered questionnaire scored based on a combination of ASAS referral and classification criteria achieved high sensitivity in identifying axial SpA in subjects referred to a rheumatology clinic. This supports its evaluation as a screening tool for axial SpA in the general population.

References:

[1]Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, et al. Cross-cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi-ethnic Asian population. Int J Rheum Dis. 2019;22(9):1652-60.

[2]Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Annals of the rheumatic diseases. 2009;68 Suppl 2:ii1-44.

[3]Poddubnyy D, van Tubergen A, Landewe R, Sieper J, van der Heijde D. Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis. Annals of the rheumatic diseases. 2015;74(8):1483-7.

[4]Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases. 2011;70(1):25-31.

Acknowledgements:

This work was supported by a Health Services Research Grant (HSRG) from the Singapore Ministry of Health National Medical Research Council [grant number: NMRC/HSRG/0075/2017].

Disclosure of Interests:

None declared

Long-term follow-up and successful treatment of pulmonary alveolar proteinosis without hypercholesterolemia with statin therapy: a case report

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the accumulation of excessive surfactant lipids and proteins in alveolar macrophages and alveoli. Oral statin therapy is a novel treatment for PAP with hypercholesterolemia. However, this treatment has never been described in a patient without hypercholesterolemia. Here, we present a case of successful treatment with atorvastatin for a patient with possibly unclassified PAP without hypercholesterolemia who responded poorly to whole lung lavage therapy and inhaled granulocyte-macrophage colony-stimulating factor. After 18 months of atorvastatin treatment, the patient experienced improvements in dyspnea, radiographic abnormalities and pulmonary function. The present case study supports the feasibility of statin therapy for PAP regardless of the level of cholesterol.

Heterogeneity response to afatinib in gastric cancer patient with uncommon epidermal growth factor receptor (EGFR) mutations: a case report

Despite concerted efforts that have been made to characterize and understand the genomic landscape of gastric cancer (GC), only HER2 has been validated as a molecular target for GC treatment. Identifying new valid therapeutic targets is important for the treatment of this disease. The present report describes a Chinese male with a history of smoking two packs per day, who did not have a family history of cancer or other hereditary diseases, we discovered a small painless lump in the right groin in February 2018. Histopathology revealed a primary gastric adenocarcinoma. Positron emission tomography-computed tomography (PET-CT) showed multiple hypermetabolic nodules in the right upper lung, greater curvature of the stomach, and muscles. The patient had received treatment included oxaliplatin, docetaxel, and tegafur for two cycles, and second-line therapy of irinotecan and capecitabine, inguinal mass excision followed by concurrent radio-chemotherapy. However, the disease rapidly progressed. Whole exome sequencing (WES) showed uncommon epidermal growth factor receptor (EGFR) mutation of G719S + L861Q. The following EGFR tyrosine kinase inhibitors (TKIs) afatinib demonstrated partial response. Two months after targeted therapy, gastroscopy indicated rapid progression. With subsequent gastric specimen WES analysis, secondary MET amplification was found. The patient received local radiotherapy for gastric lesions as well as oral administration of apatinib. However, the disease rapidly progressed. A month later, he died of hepatic encephalopathy caused by obstructive jaundice combined with pulmonary and biliary tract infection. The present study indicated that afatinib might be a beneficial therapeutic option for a subset of GC patients with rare EGFR mutation in their tumors.

Guiding-Strand-Controlled DNA Nucleases with Enhanced Specificity and Tunable Kinetics for DNA Mutation Detection

Nucleases are powerful tools in various biomedical applications, such as genetic engineering, biosensing, and molecular diagnosis. However, the commonly used nucleases (endonuclease IV, apurinic/apyrimidinic endonuclease-1, and λ exonuclease) are prone to the nonspecific cleavage of single-stranded DNA, making the desired reactions extremely low-yield and unpredictable. Herein, we have developed guiding-strand-controlled nuclease systems and constructed theoretical kinetic models to explain their mechanisms of action. The models displayed excellent agreement with the experimental results, making the kinetics highly predictable and tunable. Our method inhibited the nonspecific cleavage of single-stranded probes while maintaining highly efficient cleavage of double-stranded DNA. We also demonstrated the clinical practicability of the method by detecting a low-frequency mutation in a genomic DNA sample extracted from the blood of a patient with cancer. The limit of detection could be 0.01% for PTEN rs121909219. We believe that our findings provide a powerful tool for the field and the established model provides us a deeper understanding of the enzymatic activities of DNA nucleases.

Virtual monitoring for stable chronic hepatitis B patients does not reduce adherence to medications: A randomised controlled study

INTRODUCTION

Chronic hepatitis B (CHB) remains common in endemic regions, causing significant healthcare burden. Patients with CHB may need to be adherent to nucleoside analogue (NA) for a long period of time to prevent complications. This study aims to investigate the safety, efficacy and patient experience of a virtual monitoring clinic (VMC) in monitoring stable patients taking NA for CHB.

METHODS

Patients on NA and regular follow-up were randomised to either VMC alternating with doctors' clinic visit or to a control group in which they continued standard follow-up by doctors. Therapy adherence was measured by medication possession ratio (MPR) for NA therapy, incidence of virological breakthrough and hepatocellular carcinoma (HCC) development at two years of follow-up. Patient acceptance was measured on a Likert scale of 1-10.

RESULTS

A total 192 patients completed follow-up: 94 and 98 patients in the VMC and control groups, respectively. Mean age was 60.6 ± 10.8 years, with 95.3% Chinese ethnicity and 64.1% males. Age, gender, race, educational, employment and financial status were similar in both groups. Upon study completion, the majority of patients - 76 (80.9%) in VMC group and 74 (75.5%) in control group - had MPR ≥0.8; 88.8% were satisfied and rated VMC better than a traditional follow-up clinic with doctors only. More than 85% of patients rated ≥8/10 on the Likert scale for VMC, and preferred VMC over traditional clinic visits. Clinical outcomes observed were HCC development in one (1.1%) in the VMC group and four (4.1%) in the control group (p = 0.369). Two (2.1%) and one (1.0%) virological breakthroughs were observed in the VMC and control groups, respectively (p = 0.615). No incidence of HCC or abnormal blood tests were missed in the VMC arm.

DISCUSSION

VMC is a viable and safe clinical model for monitoring stable CHB patients on NA therapy without compromising patients' adherence to medications and is preferred by patients.

Surfactant protein D is associated with 3-month mortality of anti-MDA5 antibody-interstitial lung disease

OBJECTIVES

To investigate the associations between serum levels of matrix metalloproteinase 7 (MMP7), surfactant protein D (SPD), interleukin 18 (IL-18) and chemokine ligand 18 (CCL18) with dermatomyositis and polymyositis-associated interstitial lung disease (DM/PM-ILD) and evaluate their prognostic values in the disease.

METHODS

Seventy-eight patients with multiple disciplinary team diagnosis of DM/PM-ILD were enrolled and classified as anti-melanoma differentiation-associated protein 5 antibody (MDA5)-ILD, anti-synthetase antibodies (ARS)-ILD and other antibodies-ILD upon autoantibodies profiles. Clinical data were collected and serum levels of four biomarkers were analysed. The primary endpoint was 3-month mortality. The cut-off values of biomarkers for mortality were figured out by receiver operating characteristic (ROC) analysis. Cox regression was performed to evaluate predictive values.

RESULTS

Serum levels of MMP7 (p=0.036), SPD (p<0.001), IL-18 (p<0.001) and CCL18 (p<0.001) in patients with DM/PM-ILD were significantly higher than healthy controls with levels of MMP7 (p=0.029) and SPD (p=0.029) in patients with MDA5-ILD significantly lower than patients with ARS-ILD. The 3-month mortality in MDA5-ILD was 54.5% (12/22). Multivariate analysis showed that age (p=0.001, HR 1.151, 95% CI 1.063-1.247) and an increased level of SPD (>75.90ng/ml, p=0.005, HR 16.411, 95% CI 2.369-113.711) were significant predictors for 3-month mortality in patients with MDA5-ILD.

CONCLUSIONS

Elevated serum biomarkers were associated with DM/PM-ILD with differential levels between MDA5-ILD and ARS-ILD. Age and an increased SPD had prognostic values for predicting short-term mortality in patients with MDA5-ILD. Our study was important in providing a clue for understanding the classification and prognosis of DM/PM-ILD.

Analysis of carcinogenic signaling networks in endometrial cancer identifies RAB17 as a potential target

Endometrial cancer is one of the most common malignancies in postmenopausal women. Several potential therapeutic targets have been investigated in current research, but few have been used clinically. Therefore, further investigating the potential pathogenesis of endometrial cancer and new effective therapeutic targets for endometrial malignancies is still necessary. Our study used a The Cancer Genome Atlas dataset and two Gene Expression Omnibus datasets for weighted gene coexpression network analysis to identify important genes associated with the histological grades of endometrial cancer. In addition, we performed gene set enrichment analysis on the three datasets and found that abnormally activated signaling pathways and metabolic pathways are the main biological behaviors of endometrial cancer. Moreover, we further used different algorithms and identified the RAB17 gene as a potential study object. To further illustrate the potential role of the genes we analyzed in clinical and cellular aspects, we performed a clinical correlation analysis. Finally, we demonstrated the important roles and mechanisms of the RAB17 gene in the cell cycle, proliferation, and metastasis of endometrial cancer. Using repeated database analysis and cell-level assays, we propose RAB17 as a potential target gene for endometrial cancer for further study.

Iodine-Rich Semiconducting Polymer Nanoparticles for CT/Fluorescence Dual-Modal Imaging-Guided Enhanced Photodynamic Therapy

Photodynamic therapy (PDT) is a promising technique for cancer therapy, providing good therapeutic efficacy with minimized side effect. However, the lack of oxygen supply in the hypoxic tumor site obviously restricts the generation of singlet oxygen (¹ O₂ ), thus limiting the efficacy of PDT. So far, the strategies to improve PDT efficacy usually rely on complicated nanosystems, which require sophisticated design or complex synthetic procedure. Herein, iodine-rich semiconducting polymer nanoparticles (SPN-I) for enhanced PDT, using iodine-induced intermolecular heavy-atom effect to elevate the ¹ O₂ generation, are designed and prepared. The nanoparticles are composed of a near-infrared (NIR) absorbing semiconducting polymer (PCPDTBT) serving as the photosensitizer and source of fluorescence signal, and an iodine-grafted amphiphilic diblock copolymer (PEG-PHEMA-I) serving as the ¹ O₂ generation enhancer and nanocarrier. Compared with SPN composed of PEG-b-PPG-b-PEG and PCPDTBT (SPN-P), SPN-I can enhance the ¹ O₂ generation by 1.5-fold. In addition, SPN-I have high X-ray attenuation coefficient because of the high density of iodine in PEG-PHEMA-I, providing SPN-I the ability of use with computed tomography (CT) and fluorescence dual-modal imaging. The study thus provides a simple nanotheranostic platform composed of two components for efficient CT/fluorescence dual-modal imaging-guided enhanced PDT.

IILS: Intelligent imaging layout system for automatic imaging report standardization and intra-interdisciplinary clinical workflow optimization

Background

To achieve imaging report standardization and improve the quality and efficiency of the intra-interdisciplinary clinical workflow, we proposed an intelligent imaging layout system (IILS) for a clinical decision support system-based ubiquitous healthcare service, which is a lung nodule management system using medical images.

Methods

We created a lung IILS based on deep learning for imaging report standardization and workflow optimization for the identification of nodules. Our IILS utilized a deep learning plus adaptive auto layout tool, which trained and tested a neural network with imaging data from all the main CT manufacturers from 11,205 patients. Model performance was evaluated by the receiver operating characteristic curve (ROC) and calculating the corresponding area under the curve (AUC). The clinical application value for our IILS was assessed by a comprehensive comparison of multiple aspects.

Findings

Our IILS is clinically applicable due to the consistency with nodules detected by IILS, with its highest consistency of 0·94 and an AUC of 90·6% for malignant pulmonary nodules versus benign nodules with a sensitivity of 76·5% and specificity of 89·1%. Applying this IILS to a dataset of chest CT images, we demonstrate performance comparable to that of human experts in providing a better layout and aiding in diagnosis in 100% valid images and nodule display. The IILS was superior to the traditional manual system in performance, such as reducing the number of clicks from 14·45 ± 0·38 to 2, time consumed from 16·87 ± 0·38 s to 6·92 ± 0·10 s, number of invalid images from 7·06 ± 0·24 to 0, and missing lung nodules from 46·8% to 0%.

Interpretation

This IILS might achieve imaging report standardization, and improve the clinical workflow therefore opening a new window for clinical application of artificial intelligence.

Fund

The National Natural Science Foundation of China.

Etanercept reduces anxiety and depression in psoriasis patients, and sustained depression correlates with reduced therapeutic response to etanercept

BACKGROUND

The purpose of this study was to explore the correlation of anxiety and depression with therapeutic response to etanercept in psoriasis patients.

PATIENTS AND METHODS

One hundred and thirty-three patients with moderate-to-severe plaque psoriasis undergoing etanercept treatment were consecutively enrolled in this prospective cohort study, with all patients receiving etanercept treatment for 6 months. Psoriasis Area and Severity Index (PASI) score was evaluated at baseline (M0) and at month 1 (M1), M3 and M6 after treatment, and PASI 75/90 responses were calculated. The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score and the HADS-Depression (HADS-D) score were used to evaluate patients' anxiety and depression at M0, M1, M3 and M6. Sustained anxiety/depression were defined as HADS-A/D score≥8points both at M0 and M1.

RESULTS

Female gender and higher PASI score were associated with high risk of anxiety, while female gender, higher PASI score and longer disease duration were correlated with increased depression risk. After 6 months of etanercept treatment, 65.4% and 36.1% patients achieved PASI 75 and PASI 90 responses respectively, and both HADS-A and HADS-D scores were decreased. Most importantly, no correlation of baseline anxiety and depression with PASI 75 or PASI 90 response after 6 months of treatment was noted, while sustained depression, though not sustained anxiety, was observed to be correlated with decreased PASI 75 and PASI 90 responses.

CONCLUSIONS

Etanercept reduces anxiety and depression in psoriasis patients, and sustained depression correlates with reduced therapeutic response to etanercept.

Novel homozygous nonsense mutations in LHCGR lead to empty follicle syndrome and 46, XY disorder of sex development

Empty follicle syndrome (EFS) is a disorder associated with female infertility and presents as a complete failure to retrieve oocytes during ART cycles despite normal follicle development and careful aspiration. To date, only two EFS cases have been reported with homozygous missense mutations in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene, and both cases showed normal estradiol (E2) production during ovulation induction. The molecular genetic mechanisms of EFS remain unknown. Herein, we report two novel homozygous inactivating LHCGR mutations, c.736 C>T (p.Q246*) and c.846dupT (p.R283*), in two female EFS patients from unrelated consanguineous families. The probands had impaired E2 production during the ART process, which differs from previously reported EFS cases. The inactivating mutations not only led to EFS in the two female probands, but also resulted in 46, XY disorder of sex development (46, XY DSD) in their male siblings. As far as we know, this is the first report of LHCGR mutations leading to both EFS and 46, XY DSD within the same pedigree. Our findings provide researchers and clinicians with a better understanding of phenotype-genotype correlations between EFS and 46, XY DSD and the LHCGR gene.

Cyclosporin A-related cerebral venous sinus thrombosis: A case report

RATIONALE

Cerebral venous sinus thrombosis (CVST) is a complex life-threatening condition, and its etiology is not well understood. Although oral cyclosporin A is not a common cause of the symptoms related to CVST, there is limited information available.

PATIENT CONCERNS

In this study, we report a rare case of CVST in a 44-year-old woman with aplastic anemia, who was given cyclosporin A orally for a period of 18 months. She had experienced a headache for 20 days.

DIAGNOSES

The patient was diagnosed with CVST by computed tomography venography.

INTERVENTIONS

Low molecular heparin (enoxaparin, 4000 AXaIU, subcutaneous injection, once every 12 hours) was administered for anticoagulation.

OUTCOMES

The patient developed no recurrence of thrombosis during the 13-month follow-up period.

LESSONS

Clinicians should be aware of the possibility of CVST when patients are treated with cyclosporin A and have symptoms such as headaches.

Improved image quality of low-dose CT combining with iterative model reconstruction algorithm for response assessment in patients after treatment of malignant tumor

Background

To evaluate the image quality and radiation dose of low-dose (LD) computed tomography (LD-CT) combining with iterative model reconstruction (IMR) algorithm for response assessment in patients after treatment of malignant tumor compared with routine-dose CT (RD-CT).

Methods

Forty-seven patients [mean age 57.8±10.9 years, 30 males, body mass index (BMI) 22.09±2.35 kg/m²] after treatment of malignant tumor underwent contrast-enhanced chest and abdomen CT twice for response assessment with an interval of 6 months according to clinical routine. The first CT scans were performed with RD protocol at 120 kVp and images were reconstructed with filtered back projection (FBP) algorithm; while the second scans were performed with LD protocol at 100 kVp and images were reconstructed with FBP and IMR algorithm respectively. All scans were performed using an automatic tube current modulation technique with 150 mAs as reference. Objective image quality including CT attenuation, image noise, and contrast to noise ratio (CNR), and subjective image quality including artifacts, noise, visualization of small structures and confidence of targeted lesions, as well as lesion detection were assessed and compared.

Results

Effective radiation dose of LD-CT scans was reduced 54.8% compared to RD-CT scans (26.89±3.35 vs. 12.14±2.09 mSv). Higher CT attenuation was found in both LD-IMR and LD-FBP images compared to RD-FBP images. Better subjective image quality and CNR as well as lower objective noise were found in LD-IMR images (all, P<0.05). Two small lesions with the diameter less than 1 cm were missed in LD-FBP images, which were able to be observed in LD-IMR images.

Conclusions

IMR is able to help more than half of reduction of radiation dose without compromising the quality of diagnostic information in patients after treatment of malignant tumors to chest and abdomen CT for response assessment.

Prognostic significance of L1 cell adhesion molecule in cancer patients: A systematic review and meta-analysis

The L1 cell adhesion molecule (L1CAM) extensively participates in nervous system development and the malignant progression of human tumours. The prognostic value of L1CAM for the survival of patients with solid tumours remains controversial. The present meta-analysis was thus performed to highlight the relationship between L1CAM expression and prognosis in cancer patients. Relevant publications were identified after searching several widely used databases, including PubMed, EMBASE and the ISI Web of Science. A fixed-effect or random-effect meta-analytical model was employed to correlate L1CAM expression with different outcome measures in both entire tumours and stratified subgroups. 37 studies in total with 8552 patients were eligible for the final analysis. Combined hazard ratios (HRs) and 95% confidence intervals (CIs) suggested that high L1CAM expression had an unfavourable impact on overall survival (HR=2.06, 95%CI 1.65-2.57, P<0.001), disease-specific survival (HR=2.45, 95%CI 1.48-4.05, P<0.001), disease-free survival (HR=2.42, 95%CI 1.4-4.19, P=0.002) and progression-free survival/recurrence-free survival (HR=2.07, 95%CI 1.41-3.05, P<0.001). Subgroup analysis revealed a similar correlation in most tumour types. Overall, L1CAM might be an effective poor prognostic factor for patients with various tumour types.

Prevalence and characteristics of overweight and obesity among Chinese youth aged 12-18 years: a multistage nationwide survey

OBJECTIVE

The aims of the current study were to assess the prevalence of overweight and obesity by four different references and to explore the characteristics of adolescent overweight and obesity in Chinese secondary school students aged 12-18 years.

STUDY DESIGN

A cross-sectional study was conducted in this study.

METHODS

Using stratified random cluster sampling, 8999 secondary school students were enrolled. The references developed by Must and Dallal and Dietz, the Childhood Obesity Working Group of the International Obesity Task Force, the US Centers for Disease Control and Prevention, and the Group of China Obesity Task Force (GCOTF reference) were used to identify overweight and obese students.

RESULTS

The prevalence of adolescent overweight and obesity vary substantially based on the four references. The prevalence of adolescent overweight and obesity based on GCOTF reference are 8.4% and 4.1%, respectively, which is significantly lower than the prevalence of overweight and obesity in their peers in 2000 (χ² = 24.03, P < 0.01). The prevalence of overweight and obesity in boys are 12.0% and 5.7%, which are higher than those in girls, 4.6% and 5.7% (χ² = 240.68, P < 0.01). The prevalence of overweight and obesity in singletons are higher than those in non-singletons (χ² = 40.25, P < 0.01). The prevalence of overweight and obesity in students with lower school community ladder of subjective social status are higher than those from higher ones (χ² = 21.61, P < 0.01).

CONCLUSION

The GCOTF reference is more suitable for screening overweight and obesity in Chinese adolescents. The current prevalence rates of adolescent overweight and obesity decreased, and girls made a tremendous contribution to this decreasing trend. Singletons and adolescents in lower school community ladder of subjective socio-economic status may be at higher risk of getting overweight and obesity. More effective strategies with full consideration to the characteristics above should be developed to control and prevent adolescent overweight and obesity.

[Effects of preconditioning with hypertonic saline solution on postoperative delirium in the aged]

Objective: To evaluate and explore the mechanism of the effect of hypertonic pre-injection on postoperative delirium in the aged. Methods: From June 2016 to February 2017, participants scheduled hip arthroplasty surgery were randomly divided into four groups: Group 1 (H1) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded general anesthesia; Group 2 (H2) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded spinal canal anesthesia; Group 3 (C1) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded general anesthesia; Group 4 (C2) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded spinal canal anesthesia in Department of Anesthesiology, Third Hospital of Hebei Medical University.All these patients were operated after anesthesia.To avoid electrolyte disorder, the level of Na(+) , Ca(2+) , K(+) in the artery blood was analyzed.Peripheral venous blood was extracted to detect the concentration of inflammatory factors IL-1β, IL-6, IL-10, TNF-α and nerve injury factor S100β.In order to evaluate the relationship of these inflammatory fators with monocyte, we used flow cytometry to detect the number of mononuclear in peripheral venous blood.After operation 1 to 3 days, all these patients were assessed cognitive function by Nu-DESC. Results: Electrolytes fluctuationed in the normal range in four groups at different time points.Compared with before infusion, IL-6, IL-1β and TNF-α of four groups were significantly increased in postoperative.Compared with group H(H1 or H2), IL-1β, IL-6 and TNF-α were increased and IL-10 was decreased in group C(C1 or C2) after the surgery.S100β of group C(C1 and C2) was higher than before infusion.No significant changes were found in the cotykines mentioned above between group H1 and H2. The expression of monocytes CD14(+) CD16(+) /CD14(+ +) was decreased and the incidence of postoperative delirium was lower in group H than group C(13.3%, 10.0% vs 33.3%, 36.7%, P<0.05). Conclusion: Hypertonic saline can improve postoperative delirium of the aged and the mechanism may be related to the inhibition of monocyte cells secreting inflammatory factors.

Sensitivity of various body indices and visceral adiposity index in predicting metabolic syndrome among Chinese patients with adult growth hormone deficiency

AIM

Adult growth hormone deficiency (AGHD) refers to decreased secretion of growth hormones in the adults, which is associated with increased clustering of conventional cardiovascular risk factors such as central obesity, insulin resistance and dyslipidemia. Metabolic syndrome (MetS), a recognized risk factor of cardiovascluar diseases, shares some clinical features. Given that the prevalence of MetS is on the rise in patients with AGHD, and that cardiovascular disease (CVD) is an important cause of morbidity and mortality in that population, the alternative, simple, non-invasive methods of assessing MetS among this population are needed. This study aims to determine the sensitivity of five anthropometric indices [Body mass index (BMI), Waist circumference (WC), Waist-to-hip ratio (WHR), Waist-to-height ratio (WHtR) and Visceral adiposity index (VAI)] in predicting metabolic syndrome in Chinese population-based patients with adult growth hormone deficiency.

MATERIALS AND METHODS

A total of 96 Chinese patients with adult growth hormone deficiency were included in this study. They were compared with equal number of apparently healthy persons with similar characteristics (matched with age and gender) to the previous group. Anthropometric measurements including weight, height, serum lipids indices, blood pressure (BP), fasting plasma glucose (FPG), WC were measured. BMI, WHR, WHtR, and VAI were calculated.

RESULTS AND DISCUSSION

AGHD patients with MetS had higher WC (91.00 ± 8.28 vs 78.01 ± 7.12), BMI (24.95 ± 2.91 VS 23.30 ± 2.80), WHR (0.92 ± 0.06 VS 0.87 ± 0.07), WHtR (0.53 ± 0.06 VS 0.47 ± 0.05), VAI [(5.59 (4.02, 7.55) VS 1.69 (0.87, 3.05)] levels in comparison to those without MetS. Meantime WC, BMI, WHR, WHtR, VAI was positively correlated to MetS components. ROC curve for participants with AGHD showed that VAI had the highest SS of 92% (BMI 0.812; WHR 0.706; WHtR 0.902; VAI 0.920, respectively) for prediction of MetS in AGHD. The optimal cutoff values for different adiposity markers in predicting MetS were as follows: WC (79.65), BMI (23.46); WHR (0.89); WHtR (0.54); VAI (2.29).

CONCLUSION

In conclusion, our study showed all adiposity measures of interest present themselves as easy and practical tools for use in population studies and clinical practice for evaluating MetS in AGDH and VAI was identified as the best in Chinese AGHD patients among them.