Long-term effects of Omicron BA.2 breakthrough infection on immunity-metabolism balance: a 6-month prospective study

There have been reports of long coronavirus disease (long COVID) and breakthrough infections (BTIs); however, the mechanisms and pathological features of long COVID after Omicron BTIs remain unclear. Assessing long-term effects of COVID-19 and immune recovery after Omicron BTIs is crucial for understanding the disease and managing new-generation vaccines. Here, we followed up mild BA.2 BTI convalescents for six-month with routine blood tests, proteomic analysis and single-cell RNA sequencing (scRNA-seq). We found that major organs exhibited ephemeral dysfunction and recovered to normal in approximately six-month after BA.2 BTI. We also observed durable and potent levels of neutralizing antibodies against major circulating sub-variants, indicating that hybrid humoral immunity stays active. However, platelets may take longer to recover based on proteomic analyses, which also shows coagulation disorder and an imbalance between anti-pathogen immunity and metabolism six-month after BA.2 BTI. The immunity-metabolism imbalance was then confirmed with retrospective analysis of abnormal levels of hormones, low blood glucose level and coagulation profile. The long-term malfunctional coagulation and imbalance in the material metabolism and immunity may contribute to the development of long COVID and act as useful indicator for assessing recovery and the long-term impacts after Omicron sub-variant BTIs.

P-046 Effect of different sperm chromatin dispersion type on IVF/ICSI outcome and offspring profile

Study question

Whether the percentage of different sperm chromatin dispersion type are associated with the IVF/ICSI outcome and offspring profile?

Summary answer

Percentage of different sperm chromatin dispersion type are significantly associated with the embryo cleavage rate, embryo quality, live birth rate and offspring gender.

What is known already

The sperm DNA fragmentation index (DFI) is increasingly recognized as a key sperm functional parameter for assessing male fertility. Sperm chromatin dispersion (SCD) test is widely used in clinical andrology lab to measure DFI, and according to the size of sperm halo it divides sperm into three categories: big halo sperm, middle halo sperm, small or no halo sperm. Previous study reported that big halo sperm are significantly associated with embryo quality and pregnancy rate. The average halo size of Y-chromosome bearing sperm are significantly smaller than X - chromosome bearing sperm.

Study design, size, duration

This is a multi-center retrospective study recruited 200 couples underwent IVF/ICSI treatment in Nanfang Hospital and Guangdong Women's and Children's Hospital from May 2018 to May 2019.

Participants/materials, setting, methods

Patients meet the followed inclusion criteria were recruited: (1) The male partners received sperm chromatin dispersion test; (2) The female partners have normal ovarian reserve (female age < 35 years old, FSH ≤10 IU/L and AFC ≥ 5); (3) Couples received fresh single embryo transfer. The association between sperm chromatin dispersion type and IVF/ICSI outcome and the offspring profile were retrospectively analyzed.

Main results and the role of chance

Regression analysis showed that the embryo cleavage rate is positively associated with the percentage of sperm with big halo (Adjusted ?????(95% CI) 0.09 (0.01, 0.17), P<0.05), but negatively associated with the percentage of sperm with middle halo (Adjusted ????? (95% CI)- 0.22 (-0.35, -0.09), P<0.001). The good embryo rate is negatively associated with the percentage of sperm with middle halo (Adjusted ????? (95% CI) -0.60 (-1.04, -0.16), P<0.05). Live birth is significantly associated with the percentage of sperm with small halo (Adjusted OR (95% CI) 0.89 (0.80, 1.00), P<0.05). Offspring gender is significantly associated with the percentage of sperm with big halo (Adjusted OR (95% CI) 0.95 (0.91, 0.99), P<0.05) and the percentage of sperm with middle halo (Adjusted OR (95% CI) 1.09 (1.02, 1.17), P<0.05). The area under the receiver operator characteristic (ROC) curve (AUC) of the big halo sperm percentage to predict male offspring is 0.68 (95%CI (0.54, 0.81), P < 0.05). The AUC of middle halo sperm percentage to predict female offspring is 0.66 (95%CI (0.52, 0.80), P < 0.05).

Limitations, reasons for caution

This is a retrospective study which may have the bias caused by the nature of this type of study. The sample size is relatively small.

Wider implications of the findings

The percentage of big halo sperm are significantly associated with embryo cleavage rate and male offspring. The percentage of middle halo sperm are significantly associated with embryo cleavage rate, lower good embryo rate and female offspring. The percentage of small halo sperm is significantly associated with live birth.

Trial registration number

82101683

A diagnostic test that uses isothermal amplification and lateral flow detection sdaA can detect tuberculosis in 60 min

AIMS

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is now the leading cause of death from infectious disease, thus rapid diagnostic and screening techniques for TB are urgently needed.

METHODS AND RESULTS

Here, a detection of MTB using multiple cross displacement amplification coupling with nanoparticles-based lateral flow device (MCDA-LFD) was developed and validated, targeting the specific sdaA gene. The whole detection procedure, including rapid genomic DNA extraction (15 min), amplification (30 min) and result reporting (2 min), was completed within 50 min. No cross-reaction with non-mycobacteria and non-tuberculous mycobacteria (NTM) strains was observed. The sensitivity of sdaA-MCDA-LFD, Xpert MTB/RIF assay and culture results was 81·6, 48·3 and 37·9%, respectively, in TB patients. Among positive culture samples, the sensitivity of sdaA-MCDA-LFD and Xpert MTB/RIF assay was 93·9% (31/33) and 81·8% (27/33), respectively. Among culture-negative samples, the sensitivity of sdaA-MCDA-LFD and Xpert MTB/RIF assay was 74·1% (40/54) and 27·8% (15/54), respectively. The specificity of sdaA-MCDA-LFD and Xpert MTB/RIF was 95·4% (62/65) and 100% (65/65) in clinical samples from non-TB patients.

CONCLUSION

The sdaA-MCDA-LFD assay was a rapid, simple, specific and sensitive TB diagnostic test.

SIGNIFICANCE AND IMPACT OF THE STUDY

The sdaA-MCDA-LFD assay holds promise for application as a useful point-of-care test to detect MTB, and will play an important role in controlling and preventing TB.

0595 Obstructive Sleep Apnea Characteristics in Younger Versus Older Women

Introduction

There are few large studies of obstructive sleep apnea (OSA) comparing the clinical and polysomnographic characteristics between men and women, and between younger and older women.

Methods

The current study involves retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a prospective multicenter randomized controlled trial in persons with OSA. The mean age of the 1105 participants was 51.6 ± 12 years (range 18-83 years). The participants included 723 men (65.4%) and 382 women (34.6%). Of all women, 25% were <=45 years of age (likely pre-menopausal) and 50% were above >=53 years of age (likely post-menopausal). We used these 2 groups to define younger women and older women, respectively.

Results

The overall mean body mass index (BMI) and apnea hypopnea index (AHI) were 32.2 ± 7.1 Kg/m2 and 40.1 ± 25.2 (range 6-156/hour), respectively. Women had a higher BMI and Epworth Sleepiness Scale (ESS) than men but a lower AHI and lower arousal index (AI). The Hamilton Rating Scale for Depression (HAMD) score was also significantly higher in women. Younger men and women had no other PSG differences including total sleep time (TST), Sleep Efficiency (SE), Sleep Onset Latency (SOL). Older women had lower AHI, higher TST and higher SE than older men. Morningness-Eveningness Questionnaire (MEQ) scores were lower in women than in men in all age groups (suggestive of eveningness). Compared to the older women, younger women had higher BMI, HAMD score and ESS, but lower MEQ score. On PSG, younger women had higher TST and SE but similar SOL, AHI and AI.

Conclusion

In this cohort with OSA, the prevalence of sleepiness and depression is higher in women than in men despite a lower AHI and lower AI. Sleepiness and depression are more common in younger compared to older women with OSA despite similar AHI and AI and a higher SE. Women with OSA demonstrate more ‘eveningness’ compared to men with OSA, as do younger women compared to older women.

Support

Contract 5UO1-HL-068060 from the National Heart, Lung and Blood Institute

1047 Social Rhythm Instability Is Associated With Abdominal Adiposity After Involuntary Job Loss

Introduction

Involuntary job loss is an acute stressor that disrupts daily time structure and activity and exacerbates economic hardship and psychological distress. Studies show that unemployment is associated with negative obesity-related health outcomes, such as metabolic syndrome. However, very little is known about daily routine, depression, and obesity in individuals who have recently experienced involuntary job loss. We hypothesized that individuals with less consistent daily routines, or unstable social rhythms, after job-loss would have more abdominal adiposity than individuals with more consistent social rhythms. We also hypothesized that this relationship would vary as a function of depressive symptoms.

Methods

Cross-sectional baseline data (n = 186) from the ongoing ADAPT study (Assessing Daily Activity Patterns through occupational Transitions) were analyzed using linear regression techniques. Participants were predominantly female (62%) with a mean age of 41.12 years (SD = 10.16 years); 31% were Hispanic or Latino. Over two weeks, participants completed the daily Social Rhythm Metric-17 (SRM), Beck Depression Inventory II (BDI), and waist circumference (adiposity) measurements (cm).

Results

A significant BDI x SRM interaction was detected in the prediction of waist circumference, B = .36, SE = .18, <i> p </i> < .05, 95% CI [.002, .709], R2 = .07). The SRM was inversely associated with waist circumference, B = -5.57, SE = 2.25, <i> p </i> < .05, 95% CI [-9.98, -1.13], only at lower levels of BDI (-1 SD below the mean). Results from the Johnson-Neyman technique identified that the conditional effect of SRM on waist circumference was statistically significant at a BDI raw score of 8.33 (0-13 points is minimal depression) with ~45% of cases within this region.

Conclusion

A less consistent daily routine was associated with a larger waist circumference among individuals with minimal depressive symptoms. These findings are the first to demonstrate a relationship between social rhythm stability and abdominal adiposity in adults at high risk for central obesity. Results highlight the moderating role of depression in obesity prevention. Future prospective analysis is necessary to examine causal pathways.

Support

#1R01HL117995-01A1

[Effects and mechanism of lncRNA serving as ceRNA in non-obstructive azoospermia]

Objective: To investigate the mechanisms of lncRNA on the occurrence and development of NOA by constructing ceRNA regulation network of lncRNA, miRNA and mRNA. Methods: Samples of adult human testis were obtained from NOA patients and OA patients with normal spermatogenesis (controls), recruited from the Reproductive Medicine Center of Nanfang Hospital from June 2017 to June 2018. Differentially expressed lncRNAs and mRNAs in testicular tissues from patients with NOA were identified by microarray analysis in previous association study. In this study, differentially expressed lncRNAs and mRNA were used to construct the ceRNA regulatory network in NOA and clarify the interaction relationship among lncRNA, miRNA and mRNA. GeneMANIA database was used to construct Protein-Protein Interaction (PPI) of the mRNAs in ceRNA regulatory network. WebGestalt toolkit was employed to perform gene function and pathway enrichment analyses of those coding genes. Finally, qRT-PCR and dual luciferase reporter system were employed for further experimental validation. Results: The ceRNA regulatory network of lncRNA, miRNA and mRNA consists of 21 nodes and 26 edges, of which 4 lncRNAs, 13 miRNAs and 4 mRNAs. 19 proteins were found to interact with the mRNA coding proteins in ceRNA regulatory network by PPI analysis. Gene oncology and KEGG pathway enrichment analyses indicate these coding genes were significantly enriched in pentose metabolic process and pentose phosphate pathway. Furthermore, lncRNA ANXA2P3 was found binding with miR-613 and miR-206 to inhibit mRNA TKT expression. Conclusion: lncRNAs exert an important role in the occurrence and development of NOA via ceRNA regulatory network, which could be used as new biomarkers for NOA treatment.

Targeting C3a/C5a receptors inhibits human mesangial cell proliferation and alleviates immunoglobulin A nephropathy in mice

Complement activation has a deep pathogenic influence in immunoglobulin (Ig)A nephropathy (IgAN). C3a and C5a, small cleavage fragments generated by complement activation, are key mediators of inflammation. The fragments exert broad proinflammatory effects by binding to specific receptors (C3aR and C5aR, respectively). However, no studies thus far have investigated the effects of C3a, C5a and their receptors on IgAN. We observed that C3aR and C5aR antagonists repressed IgA-induced cell proliferation and interleukin (IL)-6 and monocyte chemotactic protein 1 (MCP-1) production in cultured human mesangial cells (HMCs). Furthermore, an IgAN mouse model induced by Sendai virus infection was employed to investigate the effects of C3aR and C5aR on IgAN in vivo for the first time. Wild-type (WT) and several knock-out mouse strains (C3aR^-/- or C5aR^-/- ) were immunized intranasally with increasing doses of inactivated virus for 14 weeks and were subjected to two intravenous viral challenges during the time-period indicated. In the Sendai virus-induced IgAN model, C3aR/C5aR-deficient mice had significantly reduced proteinuria, lower renal IgA and C3 deposition, less histological damage and reduced mesangial proliferation compared with WT mice. Both C3aR deficiency and C5aR deficiency, especially C3aR deficiency, inhibited renal tumour necrosis factor (TNF)-α, transforming growth factor (TGF)-β, IL-1β, IL-6 and MCP-1 expression significantly. However, C3aR/C5aR-deficient and WT mice with IgAN did not differ with respect to their blood urea nitrogen (BUN) and serum creatinine levels. Our findings provide further support for the idea that C3aR and C5aR are crucially important in IgAN, and suggest that pharmaceutically targeting C3aR/C5aR may hold promise for the treatment of IgAN.

The metabolic responses of HepG2 cells to the exposure of mycotoxin deoxynivalenol

As the number of reported deoxynivalenol (DON) contamination incidents increased steadily over the past decades, there has been a widespread interest in understanding the cellular mechanisms of the toxicological effects of DON using in vitro systems and omics technologies. The present investigation was conducted to understand the metabolomic changes in human hepatocellular carcinoma cells (HepG2) exposed to 10 μM DON for short term (4 h) and long term (12 h) periods, using a non-targeted metabolomics approach. Our results revealed a remarkable metabolic shift from short term to long term exposure to DON in HepG2 cells. Our metabolomics data also confirmed the role of DON induced oxidative stress in DON toxicity. Coupled with pattern recognition and pathway analysis, effects of DON on redox homeostasis, energy balance, lipid metabolism, and potential toxicological mechanisms were discussed, which would facilitate further studies on the risk assessment of the dietary mycotoxin DON.

Regulatory T and B lymphocytes in a spontaneous autoimmune polyneuropathy

B7-2(-/-) non-obese diabetic (NOD) mice develop a spontaneous autoimmune polyneuropathy (SAP) that mimics the progressive form of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). In this study, we focused on the role of regulatory T cells (Tregs ) and regulatory B cells (Bregs ) in SAP. We found that deletion of B7-2 in female NOD mice led to a lower frequency and number of Tregs and Bregs in spleens and lymph nodes. Tregs but not Bregs suppressed antigen-stimulated splenocyte proliferation, whereas Bregs inhibited the T helper type 1 (Th1) cytokine response. Both Tregs and Bregs induced an increase in CD4(+) interleukin (IL)-10(+) cells, although less effectively in the absence of B7-2. Adoptive transfer studies revealed that Tregs , but not Bregs , suppressed SAP, while Bregs attenuated disease severity when given prior to symptom onset. B cell deficiency in B cell-deficient (muMT)/B7-2(-/-) NOD mice prevented the development of SAP, which would indicate that the pathogenic role of B cells predominates over its regulatory role in this model. We conclude that Bregs and Tregs control the immunopathogenesis and progression of SAP in a non-redundant fashion, and that therapies aimed at expansion of Bregs and Tregs may be an effective approach in autoimmune neuropathies.

The use of smartphones on General Internal Medicine wards: a mixed methods study

OBJECTIVE

To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use.

METHODS

A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys.

RESULTS

Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity.

CONCLUSION

Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians.

Systematic review: the relationship between interstitial lung diseases and gastro-oesophageal reflux disease

BACKGROUND  A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM  To evaluate whether there is a causal relationship between GERD and different ILDs. METHODS  We conducted a systematic search of literature published between 1980 and 2010. After a review by two independent authors, each study was assigned an evidence-based rating according to a standard scoring system. RESULTS  We identified 319 publications and 22 of them met the entry criteria. Of those, the relationship between GERD and idiopathic pulmonary fibrosis (IPF) was investigated in 14 articles, pulmonary involvement in systemic sclerosis (SSc) in six articles and pulmonary involvement in mixed connective tissue disease (MCTD) in two articles. We found the prevalence of GERD and/or oesophageal dysmotility to be higher in patients with different types of ILD as compared with those without ILD [Evidence B]. Among patients with IPF, 67-76% demonstrated abnormal oesophageal acid exposure off PPI treatment. No relationship was demonstrated between severity of GERD and severity of IPF [Evidence B]. Data are scant on outcomes of antireflux treatment in patients with IPF. There is a correlation between the severity of ILD and the degree of oesophageal motor impairment in patients with SSc and MCTD [Evidence B]. CONCLUSIONS  Based on the currently available data, a causal relationship between GERD and idiopathic pulmonary fibrosis cannot be established. There is scant evidence about antireflux therapy in idiopathic pulmonary fibrosis patients. There may be an association between lung and oesophageal involvement in systemic sclerosis and mixed connective tissue disease, but a causal relationship cannot be established.

Implementation and evaluation of an alpha-numeric paging system on a resident inpatient teaching service

BACKGROUND

Numeric pagers are commonly used communication devices in healthcare, but cannot convey important information such as the reason for or urgency of the page. Alphanumeric pagers can display both numbers and text, and may address some of these communication problems.

OBJECTIVE

Our primary aim was to implement an alphanumeric paging system.

DESIGN

Continuous quality improvement study using rapid-cycle change methods.

SETTING

General Internal Medicine (GIM) inpatient wards at 1 tertiary care academic teaching hospital.

PARTICIPANTS

All residents, attending physicians, nurses, and allied health staff working on the general medicine (GM) wards.

MEASUREMENTS

We measured: (1) the proportion of pages sent as text pages, (2) the source of the pages, (3) the content of the text pages, (4) the pages that disrupted scheduled education activities, and (5) satisfaction with the alphanumeric paging system.

RESULTS

After implementation, 52% of pages sent from physicians or the GM wards were sent as text pages (P < 0.001). 93% of pages between physicians were text pages, compared to 27% of pages from the GM wards to physicians (P < 0.001). The most common reason for text paging among physicians was to arrange work or teaching rounds (33%). The most common reason for text paging from the GM wards was to request a patient assessment or for notification of a patient's clinical status (25%). There was a 29% reduction in disruptive pages sent during scheduled educational rounds (P < 0.001).

CONCLUSIONS

We successfully implemented an alphanumeric paging system that reduced disruptive pages on a GM inpatient service.