Increased long-term risk of heart failure and other adverse cardiac outcomes in dermatomyositis and polymyositis: Insights from a nationwide cohort

BACKGROUND

Mounting evidence suggests that dermatomyositis/polymyositis (DM/PM) are associated with increased risk of atherosclerotic events and venous thromboembolism. However, data on the association between DM/PM and other cardiac outcomes, especially heart failure (HF), are scarce.

OBJECTIVES

To examine the long-term risk and prognosis associated with adverse cardiac outcomes in patients with DM/PM.

METHODS

Using Danish administrative registries, we included all patients ≥18 years with newly diagnosed DM/PM (1996-2018). Risks of incident outcomes were compared with non-DM/PM controls from the background population (matched 1:4 by age, sex, and comorbidity). In a secondary analysis, we compared mortality following HF diagnosis between DM/PM patients with HF and non-DM/PM patients with HF (matched 1:4 by age and sex).

RESULTS

The study population included 936 DM/PM patients (median age 58.5 years, 59.0% women) and 3744 matched non-DM/PM controls. The median follow-up was 6.9 years. Absolute 10-year risks of incident outcomes for DM/PM patients vs matched controls were as follows: HF, 6.98% (CI, 5.16-9.16%) vs 4.58% (3.79-5.47%) (P = 0.002); atrial fibrillation, 10.17% (7.94-12.71%) vs 7.07% (6.09-8.15%) (P = 0.005); the composite of ICD implantation/ventricular arrhythmias/cardiac arrest, 1.99% (1.12-3.27%) vs 0.64% (0.40-0.98%) (P = 0.02); and all-cause mortality, 35.42% (31.64-39.21%) vs 16.57% (15.10-18.10%) (P < 0.0001). DM/PM with subsequent HF was associated with higher mortality compared with HF without DM/PM (adjusted hazard ratio 1.58 [CI, 1.01-2.47]).

CONCLUSION

Patients with DM/PM had a higher associated risk of HF and other adverse cardiac outcomes compared with matched controls. Among patients developing HF, a history of DM/PM was associated with higher mortality.

Estrogen enhances the expression of a growth-associated long noncoding RNA in chicken liver via ERα

1. The long noncoding RNA lncGLM is significantly differentially expressed in the livers of peak-laying hens compared with that in the livers of pre-laying hens, but its potential biological role and expression regulation are unclear.2. To explore the potential biological function of lncGLM, single nucleotide polymorphism (SNP) detection and association analysis were carried out in the Gushi×Anka F₂ resource population.3. The tissues and spatiotemporal expression characteristics of lncGLM were analysed by real-time quantitative PCR. The effects of 17β-oestradiol on the expression of lncGLM expression were analysed through in vitro and in vivo experiments.4. The results showed that a g.19069338 T > C SNP was present in lncGLM. Association analysis revealed that lncGLM was significantly associated with body slanting length at 12 weeks, body weight at 12 weeks, shank length at four weeks, chest depth at eight weeks, pelvic width at 12 weeks, eviscerated weight, head weight, pancreas weight, pectoralis weight, leg muscle weight, muscular stomach weight rate, pancreas weight rate, carcase weight, aspartate aminotransferase, creatinine and pectoral muscle water loss rate.5. The expression of lncGLM in the liver was higher than that in other sampled tissues. In addition, the expression of lncGLM in the liver was significantly higher in the peak-laying period than at the pre-laying period. Both in vitro and in vivo experiments showed that lncGLM expression was regulated by 17β-oestradiol via oestrogen receptor alpha (ER-α). These results demonstrated that the chicken lncGLM gene is highly expressed in liver tissue and regulated by oestrogen through ER-α.

Survey on recent developments in automatic detection of diabetic retinopathy

Diabetic retinopathy (DR) is a disease facilitated by the rapid spread of diabetes worldwide. DR can blind diabetic individuals. Early detection of DR is essential to restoring vision and providing timely treatment. DR can be detected manually by an ophthalmologist, examining the retinal and fundus images to analyze the macula, morphological changes in blood vessels, hemorrhage, exudates, and/or microaneurysms. This is a time consuming, costly, and challenging task. An automated system can easily perform this function by using artificial intelligence, especially in screening for early DR. Recently, much state-of-the-art research relevant to the identification of DR has been reported. This article describes the current methods of detecting non-proliferative diabetic retinopathy, exudates, hemorrhage, and microaneurysms. In addition, the authors point out future directions in overcoming current challenges in the field of DR research.

Effect of different body position on anorectal manometry for chronic constipation patients

OBJECTIVE

To analyze the different influence of body position on wireless high-resolution anorectal manometry parameters and in classification for chronic constipation patients.

PATIENTS AND METHODS

Fifty consecutive patients with chronic constipation and 20 healthy volunteers were included in this study, all of whom accepted the Rome IV constipation questionnaires, underwent rectal balloon expulsion test and wireless high-resolution anorectal manometry. The wireless high-resolution anorectal manometry was performed in the left lateral, seated, and squatting positions for every study subject. The Statistical Product and Service Solutions (SPSS) 21.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis.

RESULTS

The anal sphincter resting pressure, anal sphincter squeezing pressure, and rectal internal pressure during the evacuation in the seated position and squatting position were significantly higher than those in the left lateral position in both the volunteer group and patient group, without a significant difference between the seated position and squatting position. The initial perception threshold was higher in the patient group than in the volunteer group. The wireless high-resolution anorectal manometry in different positions combined with the rectal balloon expulsion test mainly affects the diagnosis of the subtype of inadequate defecatory propulsion.

CONCLUSIONS

Compared with the left lateral position test, the wireless high-resolution anorectal manometry in the seated position and squatting positions is more consistent with the human physiological bowel condition, and the result of the test can be affected by the body position. The wireless high-resolution anorectal manometry can differentiate between subtypes during the diagnosis of inadequate defecatory propulsion.

Effects of targeted hydration on risk of major adverse renal and cardiac events: a systematic review and meta-analysis of randomized controlled trials

Background

Inconsistent results have been published that have evaluated the preventive effect of targeted hydration in major adverse renal and cardiac events among patients exposed to contrast agents.

Methods

Online databases were searched up to October, 2019, for randomized controlled trials (RCTs). The primary outcome was the incidence of contrast-induced acute kidney injury (CI-AKI), and the secondary outcomes were all-cause in-hospital mortality, all-cause long-term mortality, requirement for dialysis, acute pulmonary edema and stroke/transient ischemic attack (TIA).

Results

9 high quality trials were identified including 2424 patients. Overall, compared with general hydration, targeted hydration significantly reduced the incidence of CI-AKI by 58% (RR 0.42; 95% CI: 0.33–0.54, p&lt;0.01), the requirement for dialysis by 68% (RR 0.32, 95% CI: 0.17–0.62, p&lt;0.01) and the all-cause long-term mortality by 55% (RR 0.45; 95% CI: 0.26–0.76, p&lt;0.01). The effect on all-cause in-hospital mortality was not statistically significant. The effect on acute pulmonary edema and stroke/TIA also showed no difference between two groups (RR: 0.54, 95% CI: 0.28–1.03, p=0.18; RR: 0.61, 95% CI: 0.14–2.61, p=0.49, respectively). Trial sequential analysis confirmed that an additional 3900 study participants would need to be recruited to demonstrate a statistically significant improvement for all-cause in-hospital mortality.

Conclusions

Targeted hydration likely reduces the incidence of CI-AKI, dialysis and all-cause long-term mortality in patients exposed to contrast agents. However, further independent high-quality RCTs should elucidate the effectiveness and safety of this prophylactic strategy in interventional cardiology.

Funding Acknowledgement

Type of funding source: None

Association of high-sensitivity C-reactive protein and long-term mortality may differ from lipoprotein(a) levels among patients undergoing coronary angiography

Background

The use of high-sensitivity C-reactive protein (hs-CRP) as an inflammation biomarker in predicting long-term mortality remains controversial. We aimed to investigate whether the association of hs-CRP with long-term mortality differs from another inflammation biomarker, lipoprotein(a), in patients undergoing coronary angiography (CAG).

Methods

A total of 2422 patients undergoing CAG were included in the final analysis from a prospective, observational study. We divided them into 4 groups according to hs-CRP level (high ≥4.8 mg/l, low &lt;4.8 mg/l) and lipoprotein(a) level (high ≥17 mg/dl, low &lt;17 mg/dl).

Results

The overall incidence of all-cause long-term mortality was 133/2422 (5.5%). In the high lipoprotein(a) group, after adjusting for LDL-cholesterol concentration (LDL-C), age, sex, smoking status, diabetes mellitus and estimated glomerular filtration rate (eGFR), a high hs-CRP level was an independent predictor of all-cause long-term mortality (hazard ratio: 2.01; 95% CI: 1.13–3.54; p=0.02). In the low lipoprotein(a) group, a similar result was not found (hazard ratio: 1.42; 95% CI: 0.92–2.01; p=0.24).

Conclusions

Our data suggested that the association of hs-CRP with all-cause long-term mortality may differ from lipoprotein(a) levels among patients undergoing CAG. In addition to hs-CRP, a high lipoprotein(a) level might be a simultaneous intervention target for improving long-term prognosis in the future.

Funding Acknowledgement

Type of funding source: None

Global risk factors of contrast-induced acute kidney injury: systematic review and meta-analysis

Background

Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors.

Methods

We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30 th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region.

Findings

We included 157 studies (2,297,863 participants). The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences.

Bubble chart of the 12 risk factors

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Science Foundation of China

Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

BACKGROUND

Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4-5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO.

METHODS

Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed.

RESULTS

A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3-4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3-0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12-45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively.

CONCLUSIONS

For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

TRAF5 promotes the occurrence and development of colon cancer via the activation of PI3K/AKT/NF-κB signaling pathways

This study aimed to investigate the expression and biological functions of TRAF5 in colon cancer at tissue and cellular levels. Forty-two patients with colon cancer were included in the present study. Tumor tissues and tumor-adjacent tissues were collected from all patients. Bioinformatics was used to analyze how TRAF5 was related to metastasis and prognosis of colon cancer. Quantitative real-time polymerase chain reaction was carried out to determine the expression of mRNA. SW620 and SW480 cells were used to study the inhibition and overexpression of TRAF5, respectively. CCK-8 assay was used to examine cell proliferation. Flow cytometry was employed to investigate cell phase and apoptosis. Transwell assay was used to study migration and invasion of cells. Western blotting was utilized to test how TRAF5 expression affected the activities of PI3K/AKT/NF-κB signaling pathways. Bioinformatics showed that the expression of TRAF5 in colon cancer tissues was correlated with metastasis and prognosis of the tumor. TRAF5 mRNA expression was up-regulated in colon cancer tissues, and related to recurrence and metastasis of the cancer. In vitro experiments showed that TRAF5 expression promoted proliferation, migration, and invasion of colon cancer cells, but reduced apoptosis of the cells. Moreover, TRAF5 might exert its biological functions by activating PI3K/AKT/NF-κB signaling pathways in colon cancer cells. In conclusion, TRAF5 expression in colon cancer tissues is up-regulated and correlated with prognosis, lymphatic metastasis and clinical staging. TRAF5 promotes the occurrence and development of colon cancer by activating PI3K/ AKT/NF-κB signaling pathways, and acts as an oncogene.

Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study

OBJECTIVES

To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak.

DESIGN

Cross-sectional study.

SETTING

Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city).

POPULATION

A total of 1947 pregnant women.

METHODS

We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis.

MAIN OUTCOME MEASURES

Anxiety status and its influencing factors. Obstetric decision-making.

RESULTS

Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding.

CONCLUSIONS

The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.

TWEETABLE ABSTRACT

The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making.

Whole-body magnetic resonance imaging is superior to skeletal scintigraphy for the detection of bone metastatic tumors: a meta-analysis

OBJECTIVE

The meta-analysis aims to compare the diagnostic performance of whole-body magnetic resonance imaging (MRI) and skeletal scintigraphy (SS) for the detection of skeletal metastases.

MATERIALS AND METHODS

We searched Medline, Scopus, Embase and Cochrane library databases for identifying fifteen eligible studies with a total of 1939 participants, and the quality of these studies was assessed according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. Sensitivities, specificities, diagnostic odds ratios (DOR), positive likelihood ratios (PLR), and negative likelihood ratios (NLR) were calculated. Summary receiver operating characteristic curves (sROC) were generated using bivariate models for whole-body MRI and skeletal scintigraphy.

RESULTS

Whole-body MRI had higher but comparable patient-based higher specificity compared to SS (99% vs. 95%). However, it had markedly higher sensitivity (94% vs. 80% respectively), DOR (966 vs. 82), and LPR (54.4 vs 17.1). LNR of whole-body MRI was <0.1 (0.06), while LNR of SS was >0.1 (0.22). The area under curves (AUC) for whole-body MRI and SS were 0.99 and 0.95 respectively.

CONCLUSIONS

We demonstrate that both whole-body MRI and SS have good diagnostic performance. However, MRI is superior for diagnostics of bone metastases, as it has higher sensitivity, higher diagnostic accuracy, and can be used for both confirmation and exclusion of metastatic bone disease.

Association of growth traits with a structural variation downstream of the KCNJ11 gene: a large population-based study in chickens

1. The potassium voltage-gated channel subfamily J member 11 gene (KCNJ11) is involved in the insulin secretion pathway. Studies have shown that mutation in this gene is associated with muscle weakness. The objective of the present study was to establish the association between KCNJ11 gene polymorphism and chicken growth performance and to analyse its expression pattern. 2. A novel 163-bp insertion/deletion (indel) polymorphism was identified in the region downstream of the KCNJ11 gene in 2330 individuals from ten populations by polymerase chain reaction (PCR). An F₂ resource population was used to investigate the genetic effects of the chicken KCNJ11 gene. Association analysis showed that the indel was significantly associated with chicken growth traits and that the phenotypic value of the ins-ins (II) genotype is higher than that of the ins-del (ID) and del-del (DD) genotypes. 3. Gene expression for different genotypes showed that birds carrying the II allele had a higher expression level than the DD genotypes. Analysis of tissue and spatiotemporal expression patterns indicated that the KCNJ11 gene was highly expressed in muscle tissues, with the highest levels in muscle tissue at one week of age, and that a 10% crude protein diet reduced the expression of this gene, average daily gain and muscle fibre diameter. 4. The results suggested that this novel 163-bp indel has the potential to become a new target for marker-assisted selection.

Cloning and expression analysis of PRL and PRLR genes in black Muscovy duck

1. Prolactin hormone (governed by the PRL gene) is secreted by the anterior pituitary of animals, which combines with its receptor (prolactin receptor, PRLR) to act on target cells. Both PRL and PRLR are mainly associated with reproductive performance. The genetic mechanism of nesting in poultry is not yet clear, and so the aim of the current study was to determine expression patterns of PRL and PRLR at different times across the breeding stages of black Muscovy ducks.2. In this study, the CDS regions of PRL and PRLR were determined by RACE sequencing. The expression levels of PRL and PRLR in the pituitary, ovary and uterus from the black Muscovy duck were compared and analysed during the pre-laying, laying and nesting periods.3. The results showed that PRL and PRLR are highly homologous in a variety of poultry species. The expression of the PRL gene in the pituitary was the highest, which was significantly higher than seen in the ovary and uterus. This trend ran through the entire prenatal period, i.e. the laying period and the nesting period. The expression level of the PRLR gene in the pituitary and ovary was generally low, and expression in the uterus was the highest. There was no significant difference in expression of the PRLR gene between pituitary and ovary during different periods, but the expression level of the PRLR gene in the uterus reached its highest level during the nesting stage, which was significantly higher than seen in the early laying period.