Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data

Designing public health responses to outbreaks requires close monitoring of population-level health indicators in real-time. Thus, an accurate estimation of the epidemic curve is critical. We propose an approach to reconstruct epidemic curves in near real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We address two data collection problems that affected the reliability of the available real-time epidemiological data, namely, the frequent missing information documenting when a patient first experienced symptoms, and the frequent retrospective revision of historical information (including right censoring). This is done by using a novel back-calculating procedure based on imputing patients' dates of symptom onset from reported cases, according to a dynamically-estimated "backward" reporting delay conditional distribution, and adjusting for right censoring using an existing package, NobBS , to estimate in real time (nowcast) cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number ( R t ) in real-time. At each step, we evaluate how different assumptions affect the recovered epidemiological events and compare the proposed approach to the alternative procedure of merely using curves of case counts, by report day, to characterize the time-evolution of the outbreak. Finally, we assess how these real-time estimates compare with subsequently documented epidemiological information that is considered more reliable and complete that became available later in time. Our approach may help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health surveillance systems in other locations.

[Association of blood lead level with cognition impairment among elderly aged 65 years and older in 9 longevity areas of China]

Objective: To investigate the association between blood lead concentrations and cognition impairment among Chinese older adults aged 65 or over. Method: Data was collected in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study between 2017 and 2018. This study included 1 684 elderly aged 65 years and older. Information about demographic characteristics, socioeconomic factors, health status and cognitive function score of respondents were collected by questionnaire survey and physical examination. Venous blood of the subjects was collected to detect the blood lead concentration. Subjects were stratified into four groups (Q₁-Q₄) by quartile of blood lead concentration. Multivariate logistic regression model was used to analyze the association between blood lead concentration and cognitive impairment. The linear or non-linear association between blood lead concentration and cognitive impairment were described by restrictive cubic splines (RCS). Results: Among the 1 684 respondents, 843 (50.1%) were female and 191 (11.3%) suffered from cognition impairment. After adjusting for confounding factors, the OR value and 95%CI of cognition impairment was 1.05 (1.01-1.10) for every 10 μg/L increase in blood lead concentration in elderly; Compared with the elderly in Q₁, the elderly with higher blood lead concentration had an increased risk of cognitive impairment. The OR value and 95%CI of Q₂, Q₃ and Q₄ groups were 1.19 (0.69-2.05), 1.45 (0.84-2.51) and 1.92 (1.13-3.27), respectively. Conclusion: Higher blood lead concentration is associated with cognitive impairment among the elderly aged 65 years and older in 9 longevity areas in China.

[Association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in 9 longevity areas of China]

Objective: To investigate the association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in China. Methods: A total of 2 393 participants aged 65 years and older were recruited in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study, during 2017 to 2018. Information on demographics characteristic, life style and health status were collected by questionnaire and physical examination, and venous blood was collected to detect the levels of blood oxidative stress and hypertriglyceridemia. The linear or non-linear association between oxidative stress and hypertriglyceridemia was described by restrictive cubic splines (RCS) fitting multiple linear regression model. The generalized linear mixed effect model was conducted to assess the association between oxidative stress and hypertriglyceridemia. Results: A total of 2 393 participants, mean age was 84.6 years, the youngest was 65 and the oldest was 112, the male was 47.9%(1 145/2 393), the triglyceride level was (1.4±0.8) mmol/L. The hypertriglyceridemia detection rate was 9.99%(239/2 393). The results of multiple linear regression model with restrictive cubic spline fitting showed that MDA level was linear association with triglyceride level; SOD level was nonlinear association with triglyceride level. MDA level had significantly association with hypertriglyceridemia, and the corresponding OR value was 1.063 (95%CI: 1.046,1.081) with 1 nmol/ml increment of blood MDA; SOD level had significantly association with hypertriglyceridemia, and the corresponding OR value was 0.986(95%CI: 0.983,0.989) with 1 U/ml increment of blood SOD. Conclusion: Among the elderly aged 65 and older in 9 longevity areas in China, MDA and SOD levels were associated with the risk of hypertriglyceridemia.

Denitrosylation of nNOS induced by cerebral ischemia-reperfusion contributes to nitrosylation of CaMKII and its inhibition of autophosphorylation in hippocampal CA1

OBJECTIVE

The aim of this study is to investigate the relation between CaMKII S-nitrosylation and its activation, as well as the underlying mechanism, after global cerebral ischemia-reperfusion.

MATERIALS AND METHODS

The rat model of cerebral ischemia-reperfusion was established by four-vessel occlusion of 15 min and reperfusion of different times. nNOS inhibitor 7-nitroindazole (7-NI), exogenous nitric oxide donor GSNO (nitrosoglutathione), or N-methyl-D-aspartate receptor (NMDAR) antagonist MK-801 were administered before ischemia. The expressions of S-nitrosylation and phosphorylation of CaMKII and nNOS were detected by biotin switch assay, immunoblotting, and immunohistochemical staining after cerebral ischemia-reperfusion. The survival of hippocampal CA1 pyramidal cells after administration of the three drugs was examined by cresyl violet staining.

RESULTS

Following cerebral ischemia-reperfusion, the S-nitrosylation of CaMKII was increased, accompanied by a decrease of phosphorylation, suggesting a decrease of activity (p<0.05). Meanwhile, the phosphorylation and S-nitrosylation of nNOS were notably decreased at the same time point (p<0.05). The administration of 7-NI, GSNO, and MK-801 increased the S-nitrosylation and phosphorylation of nNOS, leading to the attenuation of increased S-nitrosylation and decreased autophosphorylation of CaMKII after cerebral ischemia-reperfusion (p<0.05). Administration of MK-801, GSNO, and 7-NI significantly decreased the neuronal damage in rat hippocampal CA1 caused by cerebral ischemia-reperfusion (p<0.05).

CONCLUSIONS

After cerebral ischemia-reperfusion, the decrease of autophosphorylation of CaMKII regulated by its S-nitrosylation may be due to the denitrosylation of nNOS and subsequent NO production. Increasing the phosphorylation of CaMKII by nNOS inhibitor, exogenous NO donor or NMDA receptor antagonist exerted neuroprotective effects against cerebral ischemia-reperfusion injury.

FRI0259 THE CLINICAL VALUE OF GDF-15 IN ASSESSING MYOCARDIAL INVOLVEMENT OF IDIOPATHIC INFLAMMATORY MYOPATHY

Background:

Cardiac involvement is a serious complication of idiopathic inflammatory myopathy (IIM). Early diagnosis and intervention can improve prognosis. At present, myocardial biopsy is the gold standard for its diagnosis, but it is not commonly used because of its invasiveness. Biomarkers can be invoked as a non-invasive and convenient choice. The traditional markers of myocardial injury, as troponin and creatine kinase are lack specificity in inflammatory myopathy, so the novel biomarkers are getting attention.GDF-15 can predict the risk of cardiovascular disease and the prognosis of coronary atherosclerosis, heart failure and other diseases.

Objectives:

This article was intended to investigate the diagnostic value of GDF-15 for myocardial involvement in inflammatory myopathy.

Methods:

This retrospective study included 54 patients with inflammatory myopathy from May 2018 to October 2019.Of these,30 patients underwent cardiac magnetic resonance examination due to increased myocardial markers, excluding 1 case of severe lung infection. 33 patients with systemic lupus erythematosus (SLE),16 normal patients were used as the control group.The concentration of GDF-15 in the serum of all groups of patients was measured by ELISA.

Results:

1. There were significantly differences in GDF-15 levels in patients with inflammatory myopathy, systemic lupus erythematosus and normal subjects (H =39.870, P <0.001).2. 29 patients with cardiac magnetic resonance on the basis of the delayed enhancement (LGE) and ECV results were divided into two groups in which 19 patients with myocardial injury group and 10 patients without myocardial injury. The best cut-off value was calculated by ROC curve,and comparing GDF-15 and CKMB with the optimum cut-off values in predicting cardiac involvement in IIM.GDF-15 levels were statistically significant between the myocardial injury group (1765.868±1068.549 pg/ml) and the group without myocardial injury(689.967±458.12 pg/ml)(p =0.0011).At the same time, the creatine kinase isoenzyme (CKMB)(158.583±119.389 U/L vs 57.96±52.673 U/L, p =0.005) was statistically different between the two groups.3.GDF-15≥1005.3650pg/ml (AUC =0.853,95% CI 0.694-1.000) predicted myocardial involvement in inflammatory diseases with a sensitivity of 0.765 and specificity of 0.900.The AUC of the ROC curve for the joint detection of GDF-15 and CKMB was 0.888,95% CI0.757-1.000,with the predicted probability cut-off value in 0.3895, the sensitivity 0.941 and the specificity 0.800.The combined detection of the two increased the sensitivity of myocardial damage detection in IIM patients. 5. After adjusted for age, renal function, the risk of myocardial injury in IIM patients increased by an average of 0.3% per unit of GDF-15(OR =1.003,95% CI 1.000–1.005).

Conclusion:

GDF-15 can predict myocardial injury in patients with inflammatory myopathy which have high specificity.The prediction sensitivity can be improved by combining with the traditional myocardial enzyme CKMB.More further studies are needed to confirm the specific mechanism of GDF-15 for myocardial involvement to assess the prognosis of such patients and guide further treatment.

References:

[1]Sultan SM, Ioannou Y, Moss K, Isenberg DA. Outcome in patients with idiopathic inflflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 2002;41:22–6.

[2]Lundberg IE, de Visser M, Werth VP. Classification of myositis. Nat Rev Rheumatol. 2018 May;14(5):269-278.

[3]Zhang L, Wang GC, Ma L, Zu N (2012) Cardiac involvement in adult polymyositis or dermatomyositis: a systematic review. Clin Cardiol 35(11):686–691.

[4]Chen F,Peng Y,Chen M. Diagnostic approach to cardiac involvement in idiopathic inflammatory myopathies.A strategy combining cardiac troponin I but not T assay with other methods[J].Int Heart J,2018;59:256-262

Disclosure of Interests:

None declared

Transinguinal preperitoneal repair of giant inguinoscrotal hernias using Kugel mesh

INTRODUCTION

Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh.

METHODS

A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized.

RESULTS

The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120min, the median intraoperative blood loss was 75mL and the median defect area was 72 cm². The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period.

CONCLUSIONS

TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias.

The intervention of enalapril maleate and folic acid tablet on the expressions of the GRP78 and CHOP and vascular remodeling in the vascular smooth muscle cells of H-hypertensive rats with homocysteine

OBJECTIVE

GRP78 and CHOP play essential roles in endoplasmic reticulum stress (ERS) of the vascular smooth muscle cells. We aim to investigate the effect of enalapril maleate and folic acid tablet on the expressions of GRP78 and CHOP and vascular remodeling in a homocysteine (HCY)-treated hypertensive rat model.

MATERIALS AND METHODS

The hypertensive rat model was established with the technique of coarctation in the abdominal aorta, and the blood pressure of the rat was measured with the non-destructive tail-cuff method two weeks after operation. Thirty-six rats with hypertension were randomly divided into 3 groups (n=12 in each group). The control group received common diet and double distilled water, methionine group received 30 g/L methionine diet and double distilled water, while enalapril maleate and folic acid tablet group received 30 g/L methionine diet and 0.2 mg.kg-1.d-1 solution of enalapril maleate and folic acid tablet. Samples were collected at week 4 and week 8 for analysis. The plasma homocysteine was measured by homocysteine detector; MAP was detected through carotid artery incubation and aortic media thickness was determined by image analyses software. The expression of GRP78 and CHOP in the vascular smooth muscle cells were identified by immunohistochemistry and Western blot.

RESULTS

Compared with the control group, the concentration of HCY in the serum of rats in methionine group was increased significantly after 4 weeks (p < 0.01), and even more significant after 8 weeks (p < 0.01). Compared with that of methionine group, the level of HCY in enalapril maleate and folic acid tablet group rats was significantly decreased (p < 0.01). The level of MAP in methionine group was increased significantly after 8 weeks compared with that of control group (p < 0.05). However, the MAP in enalapril maleate and folic acid tablet group was decreased significantly compared with that of methionine group. Compared with control group, the media thickness of vascular smooth muscle of rats in the methionine group was increased significantly (p < 0.05) while was statistically reduced in the enalapril maleate and folic acid tablet group (p < 0.05). The expressions of GRP78 and CHOP in methionine group were significantly elevated compared to that of control in a time dependent manner (p < 0.05), which were remarkably down regulated in enalapril maleate and folic acid tablet group compared with that in methionine group.

CONCLUSIONS

The administration of enalapril maleate and folic acid tablet can maintain the normal state of cells via the alleviation of ERS and vascular damages, reduction of HCY and the thickness of arterial media as well as the improvement of vascular remodeling.

Towards high-energy, high-resolution computed tomography via a laser driven micro-spot gamma-ray source

Computed Tomography (CT) is a powerful method for non-destructive testing (NDT) and metrology awakes with expanding application fields. To improve the spatial resolution of high energy CT, a micro-spot gamma-ray source based on bremsstrahlung from a laser wakefield accelerator was developed. A high energy CT using the source was performed, which shows that the resolution of reconstruction can reach 100 μm at 10% contrast. Our proof-of-principle demonstration indicates that laser driven micro-spot gamma-ray sources provide a prospective way to increase the spatial resolution and toward to high energy micro CT. Due to the advantage in spatial resolution, laser based high energy CT represents a large potential for many NDT applications.

[Job stress in locomotive attendants in a locomotive depot and related influencing factors]

Objective: To investigate the current status of job stress in locomotive attendants in a locomotive depot and related influencing factors. Methods: From 2012 to 2013, cluster sampling was used to select 1500 locomotive attendants in a locomotive depot in Zhengzhou Railway Bureau as respondents.The contents of the investigation included general data and occupational information.A job satisfaction questionnaire was used to investigate the degree of satisfaction, a depression scale was used to investigate the frequency of symptoms, and a daily stress scale was used to investigate the frequency of fatigue and stress. Results: There was a significant difference in depression score between locomotive attendants with different ages, working years, degrees of education, working situations of spouse, total monthly family incomes, numbers of times of attendanceat night, monthly numbers of times of attendance,ormonthly attendance times(P<0.05). There was a significant difference in job satisfaction score between locomotive attendants with different ages,working years, degrees of education, working situations of spouse, total monthly family incomes, numbers of times of attendance at night, monthly attendance times,or ways to work(P<0.05). There was a significant difference in daily stress score between locomotive attendants with different ages, working years, marital status,working situations of spouse, total monthly family incomes, types of work,numbers of times of attendance at night,monthly attendance times,attendance times at night,or ways to work(P<0.05). The multiple stepwise regression analysis showed that the type of locomotive was positively correlated with job satisfaction(β=1.546)and monthly number of times of attendance,working years,attendance time at night,and degree of education were negatively correlated with job satisfaction(β=-0.185,-0.097,-0.020,and -1.106); monthly number of times of attendance andcommute time were positively correlated with depression(β=0.243 and 0.029); attendance time at night,working situation of spouse,commute time,monthly number of times of attendance,degree of education,and working years were positively correlated with daily stress(β=0.006,0.473,0.010,0.043,0.585, and 0.028). Conclusion: Number of times of attendance, attendance time,working years,and spouse are influencing factors for job stress in locomotive attendants. Improvement in work process and care for their personal life help to reduce the level of job stress.

Dentin dysplasia type I-A dental disease with genetic heterogeneity

Hereditary dentin disorders include dentinogenesis imperfecta (DGI) and dentin dysplasia (DD), which are autosomal dominant diseases characterized by altered dentin structure such as abnormality in dentin mineralization and the absence of root dentin. Shields classified DGI into three subgroups and DD into two subtypes. Although they are all hereditary dentin diseases, they do not share the same causative genes. To date, the pathogenic genes of DGI type I, which is considered a clinical manifestation of syndrome osteogenesis imperfecta, include COL1A1 and COL1A2. Mutations of the DSPP gene, which encodes the dentin sialophosphoprotein, a major non-collagenous protein, are responsible for three isolated dentinal diseases: DGI-II, DGI-III, and DD-II. However, DD-I appears to be special in that researchers have found three pathogenicity genes-VPS4B, SSUH2, and SMOC2-in three affected families from different countries. It is believed that DD-I is a genetically heterogeneous disease and is distinguished from other types of dentin disorders. This review summarizes the DD-I literature in the context of clinical appearances, radiographic characteristics, and functions of its pathogenic genes and aims to serve clinicians in further understanding and diagnosing this disease.

[Progress in research of relationship between heavy metal exposure and cardiovascular disease]

Heavy metal is one of pollutants existed widely in the environment, its relationship with cardiovascular disease has attracted more and more attention. In this review, the concentrations of heavy metals, including lead, cadium and asenic, in the body from several national surveillance networks and the epidemiological studies on the effects of the exposure of three heavy metals on cardiovascular system were summarized. It is suggested to strengthen nationwide surveillance for body concentrations of heavy metals in general population in order to provide baseline data for quantitative evaluation of the risk of heavy metal exposure on cardiovascular disease.

[Progress in research of thyroid carcinoma related gene mutation and epigenetics]

Thyroid cancer is one of the most common endocrine malignant tumors, and its molecular pathogenesis is also a process of multiple genes involved in many steps of carcinogenesis. With the development of molecular biology technology, a variety of related gene mutations and epigenetic phenomena have been found in thyroid cancer tissues. It is helpful to understand the latest progress in the research of the gene mutation and epigenetics of thyroid cancer for its early diagnosis, prevention and the development of targeted drugs.

DNA methylation and expression of imprinted genes are associated with the viability of different sexual cloned buffaloes

The DNA methylation of imprinted genes is an important way to regulate epigenetic reprogramming of donor cells in somatic cell nuclear transfer (SCNT). However, the effects of sexual distinction on the DNA methylation of imprinted genes in cloned animals have seldom been reported. In this study, we analysed the DNA methylation status of three imprinted genes (Xist, IGF2 and H19) from liveborn cloned buffaloes (L group, three female and three male), stillborn cloned buffaloes (S group, three female and three male) and natural reproduction buffaloes (N group, three female and three male), using bisulphite sequencing polymerase chain reaction (BS-PCR). The expression levels of these imprinted genes were also investigated by quantitative real-time PCR (QRT-PCR). The DNA methylation levels of H19 were not significantly different among the groups. However, the Xist in female and IGF2 in male of the S group were found to be significantly hypomethylated in comparison with the same sexual buffaloes in L group and N group (p < .05). Furthermore, the expression levels of Xist, IGF2 and H19 in the stillborn female cloned buffaloes of S group were significantly higher than that of the female buffaloes in the L group and N group (p < .05). The expression levels of IGF2 and H19 in the stillborn male cloned buffaloes in the S group were significantly higher than that of the male buffaloes in the L group and N group (p < .05). These results indicate that Xist may be associated with the viability of female cloned buffaloes, and IGF2 may also be related to the viability of male cloned buffaloes.