POS0775 APLS-ASSOCIATED RETINAL VASCULOPATHY AS A PRESENTATION OF THROMBOTIC MICROANGIOPATHY

Background:

Persistent antiphospholipid antibodies (aPL) positivity was a recognized risk factor for thrombotic events, obstetric morbidity and a variety of manifestations beyond thrombosis. The presence of some non-criteria manifestations including thrombocytopenia, hemolytic anemia, and APS nephropathy should prompt consideration for thrombotic microangiopathy (TMA).1 Patients with APS can also present with a variety of ocular and neuro-ophthalmic manifestations, such as retinal artery/vein occlusion, retinal arteritis, optic neuritis and ischemic optic neuropathy, with underlying mechanisms remained elusive. Retinal vasculopathy including retinal artery occlusion (RAO) or retinal vein occlusion (RVO) was recently found occurred more frequently in APS patients with thrombocytopenia2, suggested other possible mechanisms besides thromboembolism.

Objectives:

To explore risk factors and possible mechanisms of retinal vasculopathy among APS patients.

Methods:

In this single-center case-control study among APS patients, we evaluated patients who fulfilled 2006 Sapporo APS Classification Criteria3 with or without retinal vasculopathy during 2018-2020 at Peking Union Medical College Hospital. Demographic data, aPL-related manifestations, cardiovascular risk factors and antibodies profile were compared and a logistical regression model was built. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of variables.

Results:

A total of 310 APS patients (67.4% female, mean age 38.1 years) were included, of whom 18 patients were diagnosed with retinal vasculopathy (9 with RVO and 9 with RAO). No significant differences was found among most demographic characteristics, clinical manifestations, or antibody profile. However, APS-related heart valve disease (OR 13.66, 95% confidence interval [CI] 4.55-40.98), APS nephropathy (OR 12.77, 95% CI 4.04-40.35), thrombocytopenia (OR 2.63, 95% CI 1.01-6.89) and high serum IgM (OR 3.67, 95% CI 1.30-10.40) were predictive of retinal vasculopathy (Figure 1 A). APS-related heart valve disease and nephropathy were also found statistical significant in multivariate logistical regression (Figure 1 B). They and other non-criteria manfestations were aggregated with retinal vasculopathy from cluster analysis of variables (Figure 1 C).

Conclusion:

Patients with APS-related heart valve disease and nephropathy suffered a higher risk of retinal vasculopathy including RAO and RVO. The underlying mechanisms of aPLs-associated retinal vasculopathy may involve TMA, leading to a poor prognosis and therapeutic changes.

References:

[1]Kotzen ES, Roy S, Jain K. Antiphospholipid Syndrome Nephropathy and Other Thrombotic Microangiopathies Among Patients With Systemic Lupus Erythematosus. Adv Chronic Kidney Dis. 2019 Sep;26(5):376-386.

[2]Ermakova NA, Alekberova ZS, Reshetniak TM, Kalashnikova LA, Kosheleva NM. [Retinal vascular lesions in systemic lupus erythematosus and secondary antiphospholipid syndrome]. Vestn Oftalmol. 2005 Sep-Oct;121(5):31-6.

[3]Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.

Figure 1. A) Forest plot of univariate analysis; B) Forest plot of multivariate logistic regression; C) Cluster analysis of variables.

Disclosure of Interests:

None declared

Hydrogen gas (XEN) inhalation ameliorates airway inflammation in asthma and COPD patients

BACKGROUND

Hydrogen was proven to have anti-oxidative and anti-inflammation effects to various diseases.

AIM

We wish to investigate the acute effects of inhaled hydrogen on airway inflammation in patients with asthma and chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective study.

METHODS

In total, 2.4% hydrogen containing steam mixed gas (XEN) was inhaled once for 45 min in 10 patients with asthma and 10 patients with COPD. The levels of granulocyte-macrophage colony stimulating factor, interferon-γ, interleukin-1β (IL-1β), IL-2, IL-4, IL-6 and so on in peripheral blood and exhaled breath condensate (EBC) before and after 'XEN' inhalation were measured.

RESULTS

45 minutes 'XEN' inhalation once decreased monocyte chemotactic protein 1 level in both COPD (564.70-451.51 pg/mL, P = 0.019) and asthma (386.39-332.76 pg/mL, P = 0.033) group, while decreased IL-8 level only in asthma group (5.25-4.49 pg/mL, P = 0.023). The level of EBC soluble cluster of differentiation-40 ligand in COPD group increased after inhalation (1.07-1.16 pg/mL, P = 0.031), while IL-4 and IL-6 levels in EBC were significantly lower after inhalation in the COPD (0.80-0.64 pg/mL, P = 0.025) and asthma (0.06-0.05 pg/mL, P = 0.007) group, respectively.

CONCLUSIONS

A single inhalation of hydrogen for 45 min attenuated inflammatory status in airways in patients with asthma and COPD.

LncRNA DARS-AS1 regulates microRNA-129 to promote malignant progression of thyroid cancer

OBJECTIVE

To investigate the expression of long non-coding RNA (lncRNA) DARS-AS1 in thyroid cancer, and to further investigate whether it can promote the development of thyroid cancer by regulating microRNA-129.

PATIENTS AND METHODS

Real-time quantitative polymerase chain reaction (qPCR) was used to detect the level of DARS-AS1 in tumor tissues and paracancerous tissues of 34 thyroid carcinomas. It was also used to analyze the relationship between the expression of DARS-AS1 and the clinical indicators of thyroid cancer and the prognosis of patients. qPCR was used to further verify the expression of DARS-AS1 in thyroid cancer cell lines. The DARS-AS1 knockdown model was constructed using lentivirus in thyroid cancer cell lines. Cell counting kit-8 (CCK-8), cell clone formation, and transwell migration assays were performed to evaluate the effects of DARS-AS1 on the biological function of thyroid cancer cells. Finally, the potential mechanism was explored by using recovery experiments and the interplay between DARS-AS1 and microRNA-129 was further studied.

RESULTS

qPCR results revealed that the level of DARS-AS1 in tumor tissues of thyroid cancer patients was remarkably higher than that in adjacent tissues, and the difference was statistically significant. Compared with patients with low expression of DARS-AS1, patients with high DARS-AS1 expression had a higher incidence of high tumor stage, distant metastasis, and a lower overall survival rate. Besides, compared with NC group, the proliferation and migration ability of shRNA-AS1 expression knockdown group sh-DARS-AS1 was remarkably decreased. qPCR results indicated that there was a negative correlation between the level of microRNA-129 and DARS-AS1 in thyroid cancer tissues. In addition, cell proliferation and migration ability in the microRNA-129 overexpression group were remarkably decreased. The recovery experiment also found that there was a mutual regulation between DARS-AS1 and microRNA-129, which together affected the malignant progression of thyroid cancer.

CONCLUSIONS

DARS-AS1 level in tumor tissues of thyroid cancer was remarkably increased and was correlated with the pathological stage, distant metastasis, and poor prognosis of thyroid cancer. Moreover, DARS-AS1 could promote the proliferation and migration capabilities of thyroid cancer cells by modulating microRNA-129.

Serum soluble ST2 is a potential long-term prognostic biomarker for transient ischaemic attack and ischaemic stroke

BACKGROUND AND PURPOSE

Soluble ST2 (sST2) is a promising biomarker in inflammation, atherosclerosis and cardiovascular diseases. We investigated the association between serum sST2 and poor outcome in patients with transient ischaemic attack (TIA)/ischaemic stroke.

METHODS

Patients within 24 h after onset and with measured serum sST2 were prospectively enrolled in this study. Poor outcome was a combination of a new stroke event (ischaemic or haemorrhagic) and all-cause death within 90 days and 1 year. The associations of serum sST2 with poor outcome were analysed by Cox proportional hazards.

RESULTS

Among the 430 patients included, the median (interquartile range) sST2 was 17.72 (9.31-28.84) ng/mL. A total of 19 (4.4%) and 38 (8.8%) patients experienced poor outcome within 90 days and 1 year, respectively. Compared with the lowest sST2 tertile, hazard ratios (HRs) [95% confidence intervals (CI)] for the highest tertile were 5.14 (1.43-18.51) for poor outcome within 90 days and 3.00 (1.29-6.97) at 1 year after multivariate adjustments. Adding sST2 to a prediction model significantly improved risk stratification of poor outcome in TIA/ischaemic stroke, as observed by the continuous net reclassification improvement of 60.98% (95% CI, 15.37-106.6%, P = 0.009) and integrated discrimination improvement of 2.63% (95% CI, 0.08-5.18%, P = 0.043) at 90 days and the continuous net reclassification improvement of 41.68% (95% CI, 8.74-74.61%, P = 0.013) at 1 year.

CONCLUSIONS

Increased serum sST2 levels in TIA/ischaemic stroke were associated with increased risks of poor outcome within 90 days and 1 year, suggesting that serum sST2 may be a potential long-term prognostic biomarker for TIA/ischaemic stroke.

MiR-601 inhibits the proliferation and metastasis of esophageal squamous cell carcinoma (ESCC) by targeting HDAC6

OBJECTIVE

The aim of this study was to explore the role of microRNA-601 (miR-601) in the proliferation and invasion of esophageal squamous cell carcinoma (ESCC) cells, thereby providing new thoughts for prognosis evaluation and targeted therapy of ESCC.

PATIENTS AND METHODS

23 pairs of ESCC tissue samples and adjacent normal tissues were collected, and the expression level of miR-601 was detected. Biological information analysis and Luciferase report gene assay were used to verify the potential target genes of miR-601. Then, three groups were established in ESCC cell line (TE-1) to perform similar experiments, including the miR-NC group, the miR-601 mimics group and the mimics + HDAC6 group. Cell counting kit-8 (CCK-8) assay was used to detect cell proliferation ability. Meanwhile, transwell assay and scratch-wound assay were applied to observe the effect of miR-601 on cell invasion and migration. Quantitative reverse transcription Polymerase Chain Reaction (qPCR) and Western blot assay were applied to determine the mRNA and protein expression changes after transfection.

RESULTS

Compared with normal adjacent tissues and normal esophageal epithelial cells, the expression of miR-601 was significantly decreased in ESCC tissues and cells. HDAC6 was identified as a target gene of miR-601. The expression of HDAC6 in esophageal carcinoma cells transfected with miR-601 mimics was significantly down-regulated. The negative correlation between miR-601 and HDAC6 expression was assessed by qPCR and Western blot (WB) assay. Furthermore, miR-601 remarkably suppressed the proliferation of ESCC cells. Meanwhile, cell invasion and migration were also found markedly restricted after transfection of miR-601 mimics. However, the overexpression of HDAC6 significantly counteracted the effects of miR-601.

CONCLUSIONS

MiR-601 suppressed the proliferation, invasion and migration of esophagus carcinoma cells by down-regulating HDAC6 expression.

[Expression of ARID1A in ovarian seromucinous neoplasms and its clinicopathological significance]

Objective: To investigate the clinical, pathological and immunohistochemical features of seromucinous neoplasms, including seromucinous cystadenoma, borderline tumour and seromucinous carcinomas of the ovary. Methods: A retrospective review of the seromucinous neoplasms collected between June 2006 and December 2018 was conducted at the First Medical Center of PLA General Hospital. EnVision immunohistochemical staining was used to detect the expression of CK7, PAX8, ER, PR, WT1, p16, p53 and Baf250a which was encoded by the ARID1A gene. Results: A total of 75 ovarian seromucinous neoplasms were included. There were 30 cases of benign seromucinous cystadenoma, whose patients aged 12 to 83 years (mean, 36 years). The tumor histologically composed of endocervical-type mucinous epithelium and serous-type cells, each of which accounted for more than 10%. Among the 34 cases of seromucinous borderline tumour including 7 cases with concurrent endometriosis, the patients aged 21 to 72 years (mean, 39 years). Characteristic histologic features were broad papilla structure and an admixture of cell types, predominant endocervical-like mucinous cells (non-intestinal, no goblet cells), eosinophilic cells and others such as clear cells, hobnail cells, ciliated cells, and endometrioid cells. The larger papillae tended to have oedematous stroma containing neutrophils. In the 11 cases of seromucinous carcinomas including 2 cases with concurrent endometriosis, patients aged 26 to 61 years (mean, 40 years). Seromucinous carcinomas exhibited a predominant papillary architecture with smaller components of confluent glandular, microglandular and solid structure, expansive stromal invasion pattern, and sometimes locally destructive infiltration. An admixture of epithelial cell types was in seromucinous carcinomas, as well as borderline tumour. Immunohistochemically, the tumours were positive for CK7, PAX8, p16, estrogen receptor and progesterone receptor (positive in 10% to 80% of the cases). They were negative for WT1, while p53 staining showed a "wild-type" pattern. The Ki-67 positive rate was 20% to 60%. Loss of ARID1A-encoded protein Baf250a staining was observed in 6 (30%) of the 20 seromucinous borderline tumors, and 2 of the 11 seromucinous carcinomas. According to FIGO 2014 staging system, there were 4 cases of ⅠA, 3 cases of ⅡA and 4 cases of ⅢC. Follow-up information was available in 9 patients of seromucinous carcinomas, and 2 lost to follow-up. Eight were alive (follow-up for 6 to 108 months), including 2 patients with relapse, but 1 patient who initially presented with a stage ⅢC tumor died of disease 60 months after the cancer diagnosis. Thirty-four patients of borderline tumour were all alive at the end of follow-up, including 1 with relapse. Conclusions: Seromucinous neoplasms have characteristic histopathological and immunopathological features. Both borderline tumors and carcinomas have complex structures and cellular components. ARID1A as a tumor-suppressor gene plays a role in the oncogenesis of ovarian seromucinous neoplasms. The loss of staining with ARID1A-encoded Baf250a and wild-type p53 in seromucinous neoplasms together support that seromucinous neoplasms could be type Ⅰ tumor of dualistic model of epithelial ovarian cancer, with favourable prognosis.

SAT0241 PLATELET INDICES COULD BE SIMPLE RELIABLE PREDICTORS OF THROMBOTIC EVENTS IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME

Background:

Platelet activation is considered as a pivot pathogenic process to be responsible for thromboembolism in antiphospholipid syndrome (APS). severalstudies shown that platelet indices including platelet distribution width (PDW), mean platelet volume (MPV), large platelet rate (P-LCR) are associated with platelet activation.

Objectives:

This study aims to determine the correlation between platelet indices and thrombotic events in patients with APS.

Methods:

Platelet activation is considered as a pivot pathogenic process to be responsible for thromboembolism in antiphospholipid syndrome (APS). severalstudies shown that platelet indices including platelet distribution width (PDW), mean platelet volume (MPV), large platelet rate (P-LCR) are associated with platelet activation.

Results:

A total of 207 patients [135(65.2%) female, 72(34.8%) male], medianage 35(IQR 10)] was classified into thrombotic group (n=150,72.5%) and non-thrombotic group(n=57,27.5%). PDW, MPV, P-LCR were significantly higher in thrombotic group than non-thrombotic group (13.0±3.4 vs. 11.2±7.3)p<0.001, 10.7±1.4vs.10.0±3.0,p<0.001, 30.25±11.6vs. 25.1±10.4 p<0.001, respectively]. No differences in age, WBC count, hsCRP and C3 were observed between groups. Also, HGB was found to be notably higher in thrombotic group than non-thrombotic group (143±29 vs. 132±15, p=0.001).Upon univariate logistic analysis, PDW (OR 1.554, 95%CI 1.289-1.873, p<0.001), MPV (OR 1.772, 95%CI 1.268-2.476, p=0.001), P-LCR (OR 1.089, 95%CI 1.040-1.140, p<0.001) were all significantly associated with the occurrenceof thrombosis. In multivariate logistic analysis, only PDW and positive LAwere identified to be risk factors of thrombotic events (Table 1). The ROC curve showed that PDW combinedwith positive LAwas a reliable indicator of thrombotic events with an AUC of 0.796 (95%CI 0.728-0.864). The optimal cut-off value for PDW was 12.4fl with a sensitivity of 72.0% and specificity of 77.2%.

Conclusion:

This study confirmed that PDW, P-LCR and MPV (especially PDW) were significantly associated with thrombotic events in APS patients, which could support the theory of platelet activation being a crucial factor of thrombosis inAPS. Caution should be raised when patients with positive LA has relatively high PDW level.

Disclosure of Interests:

None declared

AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

Background:

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.

Objectives:

To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.

Methods:

Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.

Results:

17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).

Conclusion:

PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.

References:

[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737

[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253

[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13

Disclosure of Interests: :

Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

THU0544 MULTIMODAL PHOTOACOUSTIC/ULTRASONIC IMAGING SYSTEM: A NEW IMAGING METHOD FOR EVALUATING RA

Background:

Photoacoustic imaging (PAI), a new imaging technique which can be integrating with ultrasound (US) imaging, has shown potential in visualizing small joints. We have developed a multimodal photoacoustic/ultrasound (PA/US) imaging system, equipped with a handheld probe, which can provide dual-wavelength PA/US imaging to identify the micro-vessels of the inflamed articular regions and measure the oxygenation level of human inflamed synovium.

Objectives:

To validate the potential value for RA of the imaging system.

Methods:

A total of 32 RA patients received PA/US examination on seven small joints (MCP2, MCP3, PIP2, PIP3, MTP2, MTP5, and wrist of the clinically dominant side). The 0-3 score was used to semi-quantify the PA and PD signals of the inflammatory articular lesions, and the sums of PA and PD scores (PA-sum and PD-sum) were utilized. The relative oxygen saturation (SO2) values of the inflamed regions were measured by calculating the ratio of PA signals at the wavelength of 750nm and 830nm. All the patients were classified to 3 PA+SO2 patterns (Pattern 1: no or minimal PA signals; Pattern 2: evident PA signals and hyperoxia; Pattern 3: evident PA signals and hypoxia). The correlations between imaging scores and laboratory data, as well as clinical scoring systems were assessed.

Results:

A total of 32 patients of RA were recruited aged from 25-71 years-old were examined. PD-sum had moderate correlation with the clinical scores (r=0.529, 0.546, 0.490, 0.493 for DAS28ESR, DAS28CRP, SDAI, CDAI), moderate correlations with TJC (r=0.575) and SJC (r=0.491), fair correlation with VAS (r=0.239), poor correlation with PGA (r=0.153), and moderate correlation with EGA (r=0.457). The PA-sum had substantial correlations with the clinical scores (r= 0.699, 0.746, 0.723, 0.736 for DAS28ESR, DAS28CRP, SDAI, CDAI), substantial correlations with TJC (r=0.787) and SJC (r=0.694), moderate correlations with VAS (r=0.544) and PGA (r=0.529), and substantial correlation with EGA (r=0.708).

Ten patients were classified as Pattern 1, 12 as Pattern 2, 9 as Pattern 3. The PA+ SO2 patterns presented substantial correlations with the clinical scores (DAS28ESR r=0.690, DAS28CRP r=0.782, SDAI r=0.805, CDAI r=0.799, SJC r=647, TJC r=0.676, respectively), substantial correlation with VAS (r=0.714), and moderate correlation with PGA (r=0.476) and EGA (r=0.502). Significant differences between those who were classified as hypoxia and hyperoxia with evident PA signals, were detected in VAS (p=0.020) and PGA (p=0.026).

Conclusion:

The PA-sum scores and the PA+SO2 patterns can be utilized as objective imaging parameters reflecting the disease activity of RA. PAI may serve as a supplement to conventional US examinations for RA patients.

References:

[1]Backhaus, M., et al., Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum, 2009. 61(9): p. 1194-201.

[2]Colebatch, A.N., et al., EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis, 2013. 72(6): p. 804-14.

Figure 1.

the photo of the multimodal PA/US imaging system

Figure 2.

an example of the PA/US imaging

Disclosure of Interests:

Chenyang Zhao: None declared, Qian Wang: None declared, Xixi Tao: None declared, Chen Yu: None declared, Sirui Liu: None declared, Mengtao Li: None declared, Xinping Tian: None declared, Zhenhong Qi: None declared, Jianchu Li: None declared, Fang Yang: None declared, Lei Zhu: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Meng Yang: None declared, Yuxin Jiang: None declared

FRI0224 IDENTIFICATION OF RISK AND PROGNOSTIC FACTORS FOR POLYARTERITIS NODOSA PATIENTS WITH DIGITAL GANGRENE

Background:

Polyarteritis nodosa (PAN) is a segmental, necrotizing vascular disease that primarily impacts medium-sized muscle arteries. The estimated annual incidence of PAN is still lacking in China. Digital gangrene is an ischemic manifestation of the limb. However, the causes and the treatment methods vary from case to case, and the outcome is unpredictable. These features emphasize the need to identify measurable variables that accelerate digital gangrene development in PAN patients. However, little effort has been made to identify the clinical and laboratory factors that affect PAN patients with digital gangrene to anticipate their natural history and response to therapy.

Objectives:

Many patients with polyarteritis nodosa (PAN) complicated with digital gangrene have poor outcomes and related research information is limited. This study was carried out to identify the associated risk and prognostic factors.

Methods:

We conducted a retrospective study of 148 PAN patients admitted to Peking Union Medical College Hospital (PUMCH) from September 1986 to December 2018. The characteristics, therapeutic regimens, and outcome data for patients with and without gangrene were compared. The Kaplan–Meier method and Cox hazard regression model were used to evaluate the prognostic factors.

Results:

Forty-seven (31.8%) PAN patients had digital gangrene complications. The average age was 40.4±17.9 years and the average disease duration was 11 (4-27) months. The presence of digital gangrene was correlated with smoking history [odds ratio (OR), 4.27; 95% confidence interval (95% CI), 1.56-11.66] and eosinophil elevation (28.12; 10.30-76.8). Thirty-two (68.1%) gangrene patients received methylprednisolone pulse therapy and all of these patients were treated with cyclophosphamide. Nine patients suffered irreversible organ injury and two died. Disease duration ≥ 24 months and elevated serum C-reactive protein (CRP) were identified as hazardous factors for poor prognosis in patients with gangrene (P=0.003, HR=8.668, 95% CI 2.11, 35.55 andP=0.042, HR=27.062, 95% CI 1.13, 648.57, respectively).

Conclusion:

Smoking history and eosinophil elevation in PAN patients were more prone to digital gangrene and high serum CRP level predicted poor outcomes. PAN patients with smoking history and elevated eosinophils need to be seriously evaluated by clinicians. Furthermore, the CRP level should be efficiently controlled for good prognosis.

References:

[1]De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016;15:564-70.

[2]Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616-26.

[3]Xu D, You X, Wang Z, Zeng Q, Xu J, Jiang L, et al. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry VI: Effect of Cigarette Smoking on the Clinical Phenotype of Chinese Patients with Systemic Lupus Erythematosus. PLoS One. 2015;10:e0134451.

Acknowledgments:

No

Disclosure of Interests:

Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared, Lin Zhao: None declared, Shangzhu Zhang: None declared, Jiaxin Zhou: None declared, Jiu-liang Zhao: None declared, Xiaodan Kong: None declared

FRI0017 ACTIVATION OF TOLL-LIKE RECEPTORS IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF TAKAYASU ARTERITIS PATIENTS

Background:

The activation of self-specific T cells is essential in pathogenesis of Takayasu arteritis (TAK). Dendritic cell (DC) plays an indispensable role as the only antigen presenting cell for initial T cell, and Toll-like receptors (TLRs) are common source of activation signals for DCs. Then we speculate that there are activation of TLRs in TAK patients.

Objectives:

To investigate the activation of TLRs in TAK patients.

Methods:

Twenty-seven TAK patients were enrolled during April to October in 2019, with diagnosis met the 1990 criteria of American College of Rheumatology. Patient were divided into groups by the disease activity and medication history. Disease activity was assessed by the 1994 NIH criteria. Quantitative Real-time Polymerase Chain Reaction (RT-qPCR) was used to analyze the mRNA relative abundance of 28 target genes in peripheral blood mononuclear cells (PBMCs). Differences between groups and correlation between any two genes were analyzed.

Results:

The demographic data and clinical features of TAK patients were shown in Table 1. (1) Compared with health control (HC) group, mRNA abundance ofTLR2, TLR4, P50, P65, IκBα, CTLA4, CD3,andBCL6in untreated TAK group was upregulated (<0.05), whereas mRNA abundance ofCD40was downregulated (p <0.05). (2) Compared with HC group, mRNA abundance ofTLR2, TLR4, IκBα, PD-1 and BCL6in treated TAK group was upregulated (p <0.05), whereas mRNA abundance ofLAG3, CD40andTCRwas downregulated (p <0.05). (3) Compared with untreated TAK group, mRNA abundance ofP50, P65, CD28, CTLA4, TLR2, TLR4, IκBα, PD-1 and RORCwas upregulated in treated TAK group (p <0.05). (4) Compared with non-active treated TAK group, mRNA abundance ofp50, CD28, TCR, GATA3, RORC and FOXP3was upregulated in nonactive treated TAK group (p <0.05). BCL6 showed correlation with the TLRs-NFκB pathway. (Figure 1~2, Table 2)

Table 1.

Demographic data and clinical features of patients with TAK

Age (year)Gender (male/ female)Disease duration* (months)ESR (mm/h)hs-CRP* (mg/L)Interleukin 6 (pg/mL)TNFα(pg/mL)Prednisoneused/ non-usedDosage (mg/d)Treated (n=20)39.37±9.271/1943 (12, 103)14.60±8.941 (0.55, 5.625)2.1 (2, 3.95)7.56±4.3918/210 (10, 32.5) Active (n=11)39.30±7.8891/10118 (16, 166.5)16.82±10.815.63 (1.49, 8.33)3.15 (2.025, 5.775)8.42±5.5710/110 (10, 15) Nonactive (n=9)39.44±10.590/940 (12, 44)11.89±4.610.84 (0.31, 1)2 (2, 2.4)6.60±2.118/18.75 (6.875, 16.25) Pvalue0.89—0.160.340.020.080.65—0.37Untreated (n=7) Active (n=4)  1 31 M — 91 140.72 — ——0  2 25 F — 19 11.28 6.3 5.2—0  3 23 M — 71 77.36 6.3 6.2—0  4 29 F — 127 113.62 22.2 8.4—0 Nonactive (n=3)  5 34 F — 7 0.34 2 4.3—0  6 27 F — 14 0.16 25.7 4—0  7 38 F — 5 0.32 3 4—0

* median (min, max)

Table 2.

Genes expressed abnormally in PBMCs of TAK patients

Abnormally expressed in untreated TAKAbnormally expressed in treated TAKInfluenced by treatmentAssociated with the TAK activityupregulateddownregulatedupregulateddownregulatedupregulateddownregulatedUpregulateddownregulatedGenes associated with the TLRs-NFκB pathwayTLR2, TLR4, p50, p65, IκBα—TLR2, TLR4, IκBα——p50, p65p50—Positive and negative costimulatory molecules and their ligandsCTLA4CD40PD-1CD40, LAG3—CD28, CTLA4CD28—Genes associated with the activation or differentiation of T cell or B cellCD3, BCL6—BCL6TCR—CD3, TCR, RORCTCR, GATA3, RORC, FOXP3—

Conclusion:

TLRs-NFκB pathway may be activated in TAK patients, with upregulation ofBCL6, and there may be deficiency ofCD40.TLR2, TLR4, PD-1, LAG3, CD40andBCL6may play roles in the pathogenesis of TAK.p50, CD28, TCR, GATA3, RCRCandFOXP3may be related to the disease activity of TAK.

Disclosure of Interests:

Yixiao Tian: None declared, Jing Li: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals

Comparing Diagnostic Properties of the FRAIL-NH Scale and 4 Frailty Screening Instruments among Chinese Institutionalized Older Adults

OBJECTIVE

To examine the diagnostic test accuracy (DTA) of the FRAIL-NH and four frailty screening instruments among institutionalized older adults.

DESIGN

Cross-sectional study.

SETTING

Institutionalized setting, Jinan, China.

PARTICIPANTS

A total of 305 older adults (mean age 79.3 ± 8.4 years, 57.0% female) were enrolled from nursing homes.

MEASUREMENTS

Frailty was assessed by the FRAIL-NH, Physical Frailty Phenotype (PFP), FRAIL, Tilburg Frailty Indicator (TFI), and Groningen Frailty Indicator (GFI), respectively. The Comprehensive Geriatric Assessment (CGA) was used as a reference standard of frailty. The receiver operating characteristic (ROC) curve was plotted to examine the DTA of five frailty screening instruments against the CGA. The optimal cut-point was determined by the maximum value of the Youden index (YI, calculated as sensitivity + specificity - 1).

RESULTS

The prevalence of frailty ranged from 25.9% (FRAIL) to 56.4% (GFI). Areas under the curve (AUCs) against the CGA ranged from 0.80 [95% confidence interval (CI) 0.74 - 0.85: FRAIL] to 0.83 (95% CI 0.78 - 0.88: PFP). At their original cut-points, all five frailty screening instruments presented low sensitivity (32.9% - 69.3%) and high specificity (80.0% - 93.8%), as well as high positive predictive values (90.7% - 94.9%) and low negative predictive values (33.2% - 48.1%). At their optimal cut-points, the sensitivity and specificity of the FRAIL-NH, PFP, and FRAIL tended to be balanced, and their correctly classified rates (76.1% - 81.3%) and kappa values (0.465 - 0.523) increased a lot. ROC contrasts showed that all five frailty screening instruments had similarly good diagnostic accuracy (χ2: 0.0003 - 1.38, P > .05).

CONCLUSION

In the institutionalized setting, the specific FRAIL-NH, self-report FRAIL, TFI, and GFI as well as hybrid PFP, show similarly good diagnostic properties in identifying frailty against the CGA.

Development of a rapid immunochromatographic assay for detection of antibodies against porcine epidemic diarrhea virus

An immunochromatographic test strip was developed for the detection of antibodies against porcine epidemic diarrhea virus (PEDV) in porcine serum. In this test, the recombinant nucleocapsid protein of PEDV was expressed in soluble form and purified by using Ni-NTA resin and gel filtration chromatography. The purified recombinant N protein conjugated with colloidal gold was dispensed on a conjugate pad as the detector. Staphylococcal protein A and rabbit anti-N protein IgG were blotted on a nitrocellulose membrane for the test and control lines, respectively. The immunochromatographic test strip specifically detected PEDV antibodies within 10 min and had higher sensitivity (96.0%) and specificity (90.8%) than those of commercial enzyme-linked immunosorbent assay (ELISA) kits. Our newly developed strip has great potential for the early diagnosis of PEDV infection.

[Canalplasty: surgical technique and analysis of the results]

Objective:To determine the applications and results of canalplasty for closed middle ear surgery.Method:Charts of 74 ears who underwent a canalplasty and closed middle ear surgery because of chronic otitis media or middle ear cholesterol granuloma between 2012 and 2016 were reviewed for general condition, disease, surgery methods,surgical outcome,complications,results of pure tone audiometry pre-and post-operatively.Result:Sixteen(21.6%) ears have some problems of their anterior ligament of malleus.Post-operative there are 69 ears totally epithelization, of which the rate is 93.2%,and the average epithelization time is 5.3 weeks. The myringoplasties are successful on 72 ears(97.3%).There are 5 ears(6.8%) occurring complications relating to canalplasty.One year after surgery the air-bone gap has decreased by 8 dB, which has been improved significantly than pre-operative(P<0.05).Conclusion:This study shows that technique for canalplasty is safe and effective,which can exposure the whole tympanic membrane and is easy for tympanoplasty. The epithelization rate of our technique is high.And it's good for myringoplasty and hearing outcomes.

Gaseous pollutant exposure affects semen quality in central China: a cross-sectional study

BACKGROUND

Limited studies have explored the association between gaseous pollutant exposures and male reproductive outcomes, and findings remained inconsistent.

OBJECTIVES

To evaluate the potential association  between gaseous pollutants and semen quality within different exposure windows. MATERIALS AND METHODS: We adopted semen quality data of 1852 subjects who attended the Reproductive Medicine Center of Renmin Hospital at Wuhan University during January 1st, 2013, to August 3rd, 2015. A generalized linear model was employed to assess the relationship between each exposure variable and sperm parameters in different exposure windows.

RESULTS

SO₂ exposure with lag 0-90 days was significantly associated with decreased sperm concentration (β: -1.362; 95% CI: -1.844, -0.879), sperm count (β: -2.979; 95% CI: -4.267, -1.691), and PR (β: -0.551; 95% CI: -0.710, -0.393). Similar trends were observed for SO₂ exposure with three other key periods (lag 0-9, 10-14, and 70-90 days). NO₂ exposure with lag 0-90 days was also associated with decreased sperm concentration (β: -0.517; 95% CI: -1.006, -0.027), sperm count (β: -1.914; 95% CI: -3.214, -0.615), and PR (β: -0.264; 95% CI: -0.425, -0.102). No relationship between gaseous pollutant exposure and ejaculate volume was observed in any exposure window.

DISCUSSION AND CONCLUSION

Our study indicated a strong adverse effect of gaseous pollutants on semen quality outcomes during the sperm development. Gaseous pollution exposure appeared to be more detrimental in the initial phase of spermatogenesis.

Comprehensive lipidomic, metabolomic and proteomic profiling reveals the role of immune system in vitiligo

BACKGROUND

Vitiligo is a common depigmentation disorder resulting from destruction of melanocytes, and has both genetic and environmental influences. Although genomic analyses have been performed to investigate the pathogenesis of vitiligo, the lipidomics, metabolomics and proteomics of serum have not been reported, and the role of small molecules and serum proteins in vitiligo remains unknown.

AIM

To study the metabolite and protein profiles in patients with vitiligo and healthy controls (HCs).

METHODS

Plasma samples from 60 participants (29 patients with vitiligo and 31 HCs) were analysed. Untargeted lipidomics, metabolomics and isobaric tags for relative and absolute quantification-based proteomics were performed using high performance liquid chromatography-tandem mass spectrometry. In addition, to validate differentially expressed metabolites in patients with vitiligo, plasma enzyme-linked immunosorbent assay was performed.

RESULTS

We identified differential expression of several metabolites and proteins involved in the immune system. Among these metabolites and proteins, lysophosphatidylcholine, platelet-activating factor, sn-glycerol-3-phosphocholine, succinic acid, CXCL4 and CXCL7 were significantly elevated in the plasma of patients with vitiligo, while aspartate was downregulated.

CONCLUSION

Our study has characterized several serum metabolites and proteins that could be potential candidate biomarkers in vitiligo, and provides a comprehensive insight into the role of immune system and aspartate metabolism in vitiligo.

Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) Registry XI: gender impact on long-term outcomes

OBJECTIVE

The objective of this paper is to assess the role of gender on survival rate and causes of death and organ damage in systemic lupus erythematosus (SLE) patients in China from 2009 to 2015.

METHODS

We conducted a multicenter cohort study to analyze the differences in outcome data between male and female SLE patients. A group of 1494 SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were enrolled in the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) registry from April 2009 to February 2010. All enrolled patients were followed up at least once per year from 2009 to 2015. For patients who could not attend the outpatient clinic, follow-up was conducted by telephone interview. We collected demographic data, clinical manifestations and damage scores (System Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)). Survival rates were evaluated using the Kaplan-Meier method.

RESULTS

This study included 1352 women and 142 men. The five-year survival rates were 92.0% for men and 97.6% for women. The survival rates of males were significant lower than for females ( p = 0.019). Male patients received methylprednisolone pulse therapy and cyclophosphamide significantly more than female patients ( p = 0.010). During follow-up, 12 male patients and 66 female patients died. The most common cause of death was infection (41.7%) for men and active SLE disease (27.3%) for women. At the end of the study, the major accumulated organ damages included renal (8.5%) and musculoskeletal (7.7%), and nervous system (5.6%) for men and renal (8.8%) and musculoskeletal (6.7%) for women. There were no significant differences in SDI scores between the two groups at baseline and at the end of the study.

CONCLUSIONS

Male SLE patients had lower survival rates than female patients. Male patients received more methylprednisolone pulse and cyclophosphamide therapy. The most common causes of death were infection for male patients and active SLE disease for female patients. The major accumulated organ damages were renal, musculoskeletal, and nervous system both for male and female SLE patients in China.

Search for Sterile Neutrinos in MINOS and MINOS+ Using a Two-Detector Fit

A search for mixing between active neutrinos and light sterile neutrinos has been performed by looking for muon neutrino disappearance in two detectors at baselines of 1.04 and 735 km, using a combined MINOS and MINOS+ exposure of 16.36×10^{20} protons on target. A simultaneous fit to the charged-current muon neutrino and neutral-current neutrino energy spectra in the two detectors yields no evidence for sterile neutrino mixing using a 3+1 model. The most stringent limit to date is set on the mixing parameter sin^{2}θ_{24} for most values of the sterile neutrino mass splitting Δm_{41}^{2}>10^{-4}  eV^{2}.

Dual antiplatelet therapy reduced stroke risk in high-risk patients with transient ischaemic attack assessed by ABCD3-I score

BACKGROUND AND PURPOSE

Several clinical trials have demonstrated that dual antiplatelet therapy (DAPT) benefited patients with transient ischaemic attack (TIA) with an ABCD2 score ≥4. The present study aimed to investigate whether the ABCD3-I score could be a more appropriate tool for selection of patients with TIA to receive DAPT in real-world settings.

METHODS

We derived data from the TIA database of The First Affiliated Hospital of Zhengzhou University. The predictive outcome was ischaemic stroke at 90 days. The additive interaction effect was presented by the attributable proportion due to interaction. Kaplan-Meier curves were plotted to present cumulative stroke rates in different risk categories with monotherapy and DAPT. Cox proportional hazards regression was used to determine risk factors associated with stroke.

RESULTS

Among 785 patients, the mean (SD) age was 56.95 (12.73) years and 77 patients (9.8%) had an ischaemic stroke at 90 days. A total of 55.8% of patients (attributable proportion due to interaction; 95% confidence interval, 20.8%-90.9%) were attributed to additive interaction of ABCD3-I score and antiplatelet therapy. Kaplan-Meier curves showed a significant difference between patients receiving monotherapy and DAPT in high-risk patients with TIA (P = 0.021). DAPT reduced 90-day stroke risk in high-risk patients with TIA as assessed independently by ABCD3-I score (adjusted hazard ratio, 0.43; 95% confidence interval, 0.20-0.92, P = 0.031). The benefit did not exist in low- and medium-risk patients by ABCD3-I score (patients with ABCD2 score ≥ 4 or <4).

CONCLUSIONS

High-risk patients with TIA assessed by ABCD3-I score received the most pronounced clinical benefit from early use of DAPT in real-world clinical experience.

Safety and efficacy of vesatolimod (GS-9620) in patients with chronic hepatitis B who are not currently on antiviral treatment

Vesatolimod is an oral agonist of toll-like receptor 7 designed to minimize systemic exposure and side effects. We assessed the safety and efficacy of vesatolimod in viremic chronic hepatitis B (CHB) patients not currently on oral antiviral treatment (OAV) in a phase 2, multicentre, double-blind, randomized, placebo-controlled study. A total of 192 patients stratified by HBeAg status and alanine aminotransferase level were randomized 2:2:2:1 to receive oral vesatolimod (1-, 2- or 4-mg) or placebo once weekly for 12 weeks; tenofovir disoproxil fumarate (300-mg daily) was administered daily for 48 weeks. Efficacy was assessed by quantitative serum HBsAg decline at Week 24 from baseline. In addition to safety assessments, changes in whole-blood interferon-stimulated gene (ISG) transcripts and serum cytokines were explored. Most patients were male (64.1%) and HBeAg-negative (60.9%) at baseline. Among vesatolimod-treated patients, most (60.4%-69.1%) experienced ≥1 treatment-emergent adverse event; the majority were mild or moderate in severity. No clinically meaningful differences in HBsAg changes from baseline were observed between treatment groups. No patients experienced HBsAg loss, while 3 patients experienced HBeAg loss and hepatitis B e-antibody seroconversion at week 48. HBV DNA suppression rates were similar across all treatment arms at Week 24. ISG15 induction was dose-dependent and did not correlate with HBsAg changes. A small proportion of patients exhibited dose-dependent interferon-α induction that correlated with grade of influenza-like adverse events. Overall, vesatolimod is safe and well tolerated in CHB patients. Although consistent dose-dependent pharmacodynamic induction of ISGs was demonstrated, it did not result in clinically significant HBsAg decline.

Molecular characterization, expression pattern and metabolic activity of flavin-dependent monooxygenases in Spodoptera exigua

Enhanced detoxification is one of the important mechanisms for insecticide resistance. Most research in this field to date has focused on the role of cytochrome P450s. Our previous work revealed that flavin-dependent monooxygenases (FMOs) were involved in metabolic resistance of Spodoptera exigua. In the present study we investigated the molecular characteristics, expression patterns and oxidative activities of SeFMO on insecticides. Three FMO genes, which encode proteins with the typical FMO motifs, were cloned from S. exigua. The oxidative activities of eukaryotically expressed SeFMO enzymes were verified with the model substrate of FMO. Importantly, the SeFMOs had significantly higher oxidative activities on metaflumizone and lambda-cyhalothrin than on model substrates and other insecticides tested. The three SeFMOs were mainly expressed in the midgut, fat body and Malpighian tubules. The tissues responsible for xenobiotic metabolism and their expression characteristics were similar to those of P450s acting as detoxification genes. The study also revealed that the expression of SeFMOs could be induced by insecticide exposure, and that SeFMOs were over-expressed in a metaflumizone-resistant strain of S. exigua. These results suggest that SeFMOs are important insecticide detoxifying enzymes, and that over-expression of FMO genes may be one of the mechanisms for metabolic resistance in S. exigua.

The involvement of AQP1 in myocardial edema induced by pressure overload in mice

OBJECTIVE

To investigate the effect of aquaporin-1 (AQP1) on heart edema induced by transverse aortic constriction (TAC) in mice, and to explore whether inhibiting the expression of AQP1 could attenuate myocardial edema and improve cardiac function.

MATERIALS AND METHODS

The C57BL/6 mice were divided into four groups: (1) the sham group; 2) the sham + acetazolamide group: mice were orally gavaged with acetazolamide (20 mg/kg/day) after sham operation; (3) the TAC group: a mouse model of pressure overload induced by TAC for two weeks; (4) the TAC + acetazolamide group: mice were orally gavaged with acetazolamide (20 mg/kg/day) after TAC. Cardiac function was detected by echocardiography after 2 weeks' TAC. The ratio of heart weight to body weight (HW/BW) and myocardial water content were calculated. The mRNA and protein expressions of AQP1 were measured by reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blot, respectively.

RESULTS

Significant myocardial hypertrophy and dysfunction were found in TAC mice. The ratio of HW/BW, myocardial water content, and the mRNA and protein expression of AQP1 of the TAC group were markedly higher than those of the sham group. By contrast, acetazolamide administration reduced the ratio of HW/BW and myocardial water content, whereas improved cardiac dysfunction induced by TAC. Moreover, acetazolamide reduced the mRNA and protein expression of AQP1 in TAC mice.

CONCLUSIONS

The expression of AQP1 was closely related to myocardial edema induced by TAC. The inhibition of AQP1 could reduce myocardial edema and improve cardiac dysfunction.

Influence of light intensity on chloroplast development and pigment accumulation in the wild-type and etiolated mutant plants of Anthurium andraeanum 'Sonate'

Seedlings of wild-type and etiolate mutant plants of Anthurium andraeanum cultivar 'Sonate' were treated for 15 d with different light intensities (20, 100, and 400 µmol·m^-2·s^-1) to analyze leaf plastid development and pigment content. Significant changes appeared in treated seedlings, including in leaf color, plastid ultrastructure, chloroplast development gene AaGLK expression, chlorophyll and anthocyanin contents, and protoplast shape. Wild-type and etiolated plants exhibited different plastid structures under the same light condition. The results suggest that light intensity is a crucial environmental factor influencing plastid development and leaf color formation in the A. andraeanum cultivar 'Sonate'.

Clinical Significance of Intraplaque Hemorrhage in Low- and High-Grade Basilar Artery Stenosis on High-Resolution MRI

BACKGROUND AND PURPOSE

Intraplaque hemorrhage within intracranial atherosclerotic plaques identified by high-resolution MR imaging has been studied as a potential marker of stroke risk. However, previous studies only examined intracranial arteries with high-grade stenosis (degree of stenosis, >50%). This study aimed to ascertain the clinical relevance of intraplaque hemorrhage in patients with low- and high-grade stenotic basilar artery plaques.

MATERIALS AND METHODS

Patients with basilar artery stenosis (n = 126; mean age, 62 ± 10 years; 66 symptomatic and 60 asymptomatic) underwent high-resolution MR imaging. The relationship between imaging findings (intraplaque hemorrhage, contrast enhancement, degree of stenosis, minimal lumen area, and plaque burden) and symptoms was analyzed.

RESULTS

Intraplaque hemorrhage was identified in 22 patients (17.5%), including 21 (31.8%) symptomatic patients and 1 (1.7%) asymptomatic patient. Multivariate analysis showed that intraplaque hemorrhage was the strongest independent marker of symptomatic status (odds ratio, 27.5; 95% CI, 3.4-221.5; P = .002). Contrast enhancement was also independently associated with symptomatic status (odds ratio, 9.9; 95% CI, 1.5-23.6; P = .016). Stenosis, minimal lumen area, and plaque burden were not correlated with symptoms (P > .05). Intraplaque hemorrhage was present in both low- and high-grade stenotic basilar arteries (11.3% versus 16.3%, P = .63). Diagnostic performance values of intraplaque hemorrhage for patients with acute/subacute symptomatic stroke were the following: specificity, 98.3%; sensitivity, 31.8%; positive predictive value, 95.5%; and negative predictive value, 56.7%.

CONCLUSIONS

Intraplaque hemorrhage is present in both low- and high-grade stenotic basilar artery plaques and is independently associated with symptomatic stroke status. Intraplaque hemorrhage may identify high-risk plaque and provide new insight into the management of patient with stroke without significant stenosis.

Oral peripheral ameloblastoma: A retrospective series study of 25 cases

Background

Peripheral ameloblastoma (PA) is a rare and unusual variant of odontogenic tumor, which was described only in isolated case reports in literature. The objective of this study was to investigate the clinical profile, treatment and outcome of PA in a consecutive case series.

Material and Methods

A total of 25 patients with histologically confirmed PA from 2001 to 2015 were retrospectively reviewed in our institution.

Results

Of the 25 patients, 22 males and 3 females were identified (male: female = 7.3:1). The average age was 48.3 years (range 11-81 years) with lingual or palate gingival region being the most common site (76%). The course of disease was less than 6 months in 92.0% (23/25) of all patients (mean, 3.3 months; range, 1-12 months). All patients underwent complete surgical removal of the lesions, and one lesion recurrence occurred during the follow-up period.

Conclusions

The clinical profile and outcome of PA from Eastern China were elucidated in this retrospective analysis based on a case series. Our experience may provide some insights into the differential diagnosis and clinical management of PA. The first choice of treatment is surgical excision, which can result in a good prognosis.

Key words:Peripheral ameloblastoma, clinical profile, outcome.

Differential expressions of MDM2 and TAP73 in cancer and cancer-adjacent tissues in patients with non-small-cell lung carcinoma

AIM

To investigate the differences in mRNA and protein expressions of MDM2 (mouse double minute 2 homolog) and P73 in cancer and cancer-adjacent tissues in patients with non-small-cell lung carcinoma (NSCLC).

MATERIALS AND METHODS

We compared the protein expressions of MDM2 and P73 in lung cancer and cancer-adjacent tissues in NSCLC patients by IHC (immunohistochemistry) and WB (Western blot). We divided the NSCLC patients into two subgroups, adenocarcinoma and squamous carcinoma. The mRNA expressions of two main isoforms of P73, TAP73 and DNP73, as well as the ratio of DNP73/TAP73 were analyzed by qPCR (quantitative real-time PCR) in the two tissues in all NSCLC patients and in patients with adenocarcinoma or squamous carcinoma, respectively.

RESULTS

WB results did not show significant differences in MDM2 and P73 protein expressions in lung cancer and cancer-adjacent tissues. However, IHC results indicated that MDM2 expression significantly increased in cancer tissues in female patients, but not male patients. In addition, TAP73 mRNA expression significantly increased in cancer tissues in all NSCLC patients (p=0.002) and in patients with adenocarcinoma (p=0.01); while there was no significant difference in DNP73 mRNA expression. Hence the fold-change of DNP73/TAP73 ratio significantly decreased (p=0.0003) in cancer tissues in all NSCLC patients and in patients with adenocarcinoma.

CONCLUSIONS

TAP73 mRNA expression significantly increased in cancer tissues than cancer-adjacent tissues in all NSCLC patients and in patients with adenocarcinoma. Meanwhile, the fold-change of DNP73/TAP73 ratio was similar to TAP73. MDM2 protein expression significantly increased in cancer tissues in female NSCLC patients.

Retinal changes following rapid ascent to a high-altitude environment

PurposeTo determine what impact rapid ascension to a high-altitude environment has on the retina with the aim of preventing and treating high-altitude oculopathy.Patients and methodsParticipants in the study were members of the Chinese military assigned to the high-altitude environment of the Tibetan plateau. Ninety-one participants were enrolled in the study. Optical coherence tomography was used to measure the thickness of retina-related indicators. Measurements were taken before and after exposure to the high-altitude environment and upon return to the baseline altitude.ResultsFollowing exposure to the high-altitude environment in Tibet, there was a significant increase in retinal nerve fiber layer (RNFL) thickness in the temporal and nasal quadrants of the optic disc, whilst a significant decrease in RNFL thickness in the inferior optic disc was also observed. A significant increase in RNFL thickness in the superior and inferior macula was also evident, along with a significant increase in the ganglion cell layer thickness in the superior macula. Upon return to the baseline altitude, all measurements returned to baseline levels except for the RNFL of the inferior macula, which was significantly thicker. Pathological changes were also documented in the eyes of nine participants upon returning to baseline altitude, including ischemic optic neuropathy, myopia, and cortical amaurosis.ConclusionsThe high-altitude environment can have a negative impact on the health of the retina and may contribute to the incidence of various eye diseases. This study deepens the understanding of what impact a high-altitude environment has on retina and provides reliable data for blindness prevention and treatment.

109 Dosage Compensation of the X Chromosome in Ovine Embryos, Late Gestation, and Adult Somatic Tissues

Deviations from proper gene dosage of the autosome range from severe to lethal consequences in mammals. Eutherian males (XY), however, have reduced gene dosage compared with females (XX) due to a single X and deteriorating Y chromosome. This dosage imbalance is resolved through X chromosome dosage compensation, according to Ohno’s hypothesis: X-linked gene expression is doubled in both males and females to balance expression of the X chromosome and autosomes. To compensate for doubled X chromosome expression in females, X chromosome inactivation (XCI) inactivates a single X chromosome in each cell. Although these mechanisms have been well studied in mice and humans, controversies exist due to the analysis and interpretation of RNA sequencing data. Here we described X chromosome dosage compensation in the sheep. Twelve ewes were fed 100% (control), 60% (restricted), or 140% (overfed) of the National Research Council requirements for a ewe pregnant with twins (NRC, 1985; Nutrient Requirements of Sheep, 6th ed.). Day 135 brain, lung, and kidney tissues were collected from fetuses of the control, restricted, and overfed groups (n = 7, 4, and 4; respectively). RNA seq libraries were prepared using the Illumina TruSeq stranded mRNA kit and sequenced on the NextSEqn 500 (Illumina Inc., San Diego, CA, USA). Two additional RNA-seq datasets were downloaded from Sequence Read Archive (SRA), including Day 14 embryos (PRJNA254105), and adult and juvenile heart, brain, liver, muscle, rumen, and female- and male-specific tissues (PRJEB6169). The RNA-seq data were trimmed and mapped to the ovine reference genome assembly Oar_v4.0 using Hisat2 (version 2.0.5; https://ccb.jhu.edu/software/hisat2/index.shtml) aligner. The mRNA level of each gene was estimated by transformed transcripts per kilobase million (TPM) and was quantified using IsoEM (version 1.1.4; http://dna.engr.uconn.edu/). The relative expression of X to autosomal (A)(RXE) was calculated using RXE = log2(X expression) – log2(A expression) with an average of 486 X-linked genes and 13,001 autosomal genes after TPM >1 filtering. RXE ≥0 (or X:A ratio ≥ 1); <0, = –1 indicate complete, incomplete, or no dosage compensation; respectively. Control, restricted, and overfed ovine fetal somatic tissues displayed incomplete dosage compensation. Incomplete dosage compensation was also observed in juvenile and adult somatic major organs and female specific tissues. Brain tissues, apart from the cerebellum, displayed complete dosage compensation with an RXE range of 0 to 0.16. An interesting pattern was observed in the male specific tissues with complete dosage compensation in the epididymis (RXE = 0.32) and incomplete dosage compensation in the testes (RXE = –0.84). No significant RXE differences were observed between ovine female and male somatic tissues, supporting Ohno’s hypothesis of balanced expression of X-linked genes to autosomal genes. Our results indicate that a mechanism for dosage compensation exists in the sheep, although it is largely incomplete.

Protective effects of Nano-elemental selenium against chromium-vi-induced oxidative stress in broiler liver

The valuable role of selenium in mitigation of oxidative stress and heavy metal toxicity is well-known. Thus, the aim of the current study on broiler chickens was to examine whether nano elemental selenium (Nano-Se) supplementation can reduce the effects of chromium VI (K2Cr2O7) toxicity. For this purpose, a total of 150, one-day-old broiler chickens were allotted to five groups with three replicates: control group (standard diet), poisoned group (K2Cr2O7 via drinking water), protection group (K2Cr2O7 + Nano- Se), cure group (K2Cr2O7 for initial 2 weeks and then Nano-Se), and prevention group (opposite to the cure group). The broilers were detected by the activities of marker enzymes and oxidative stress markers including, aspartate aminotransferase (AST), alanine transaminase (ALT), gamma-glutamyl transferase (GGT) and superoxide dismutase (SOD), glutathione peroxidase (GSH-px), malondialdehyde (MDA), respectively. The (K2Cr2O7 administration caused histopathological damage in the liver of the chickens. Moreover, changes in serum biochemical indicators and oxidative stress parameters were also observed. Nano-Se supplementation increased the levels of GSH-px but reduced the activities of SOD, MDA, GGT, ALT and AST in the experimental groups (P less than 0.05). Our results showed that Nano-Se plays a protective role by preventing the oxidative stress induced by the chromium VI in broiler chickens.

Exome sequencing identifies a TCF4 mutation in a Chinese pedigree with symmetrical acral keratoderma

BACKGROUND

Symmetrical acral keratoderma (SAK) is a rare skin disorder and its pathogenesis and inheritability are unknown.

OBJECTIVES

To investigate the inheritance and pathogenesis of SAK.

METHODS

Four SAK cases occurred in a four-generation Chinese family. Exome sequencing identified SNPs with potential SAK-related mutations, and a potentially responsible gene transcription factor 4 (TCF4) was identified. TCF4 was then sequenced in all 11 family members, and pedigree analysis was performed. Histopathology and immunohistochemistry evaluated TCF4 expression in skin lesions. The gene mutation was investigated in human keratinocytes for keratin-related protein expression.

RESULTS

A novel heterozygous missense mutation, c.85C>A (p.Pro29Thr) was found in TCF4. The mutation showed autosomal dominant inheritance and perfectly cosegregated with the SAK phenotype in all family members. In skin lesions, TCF4 was present in the cytoplasm and membranes of the basal layer, the stratum spinosum and the stratum granulosum of the epidermis. The mutant TCF4 induced overexpression of differentiation markers including KRT1, KRT14, loricrin and involucrin.

CONCLUSIONS

A SAK-related gene mutation in TCF4 may function through transcriptional regulation of keratin.

[Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke]

Objective: To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia. Methods: A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data. Results: The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM. Conclusions: New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.