OP0093 FREQUENCIES AND PREDICTORS OF THE LUPUS LOW DISEASE ACTIVITY STATE AND REMISSION IN TREATMENT-NAÏVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS -- A REAL-WORLD COHORT STUDY

Background:

After the introduction of treat-to-target strategy in systemic lupus erythematosus (SLE), Lupus Low Disease Activity State (LLDAS) and definitions of remission in SLE (DORIS) were developed and validated. Several studies had demonstrated that the achievement and maintenance of LLDAS or DORIS was associated with good prognosis.

Objectives:

To evaluate the attainability of LLDAS and DORIS in a treatment-naïve cohort of SLE.

Methods:

LDAS5 was defined as LLDAS with a prednisone dose ≤5 mg/d. There were 4 definitions in DORIS: clinical remission on treatment (RONT), complete RONT, clinical remission off treatment (ROFT) and complete ROFT. The treatment-naïve patients from Peking University First Hospital SLE cohort were enrolled. The time to each state and their annual cumulative probabilities were estimated by Kaplan-Meier approach. The frequencies of patients who achieved each component of LLDAS or DORIS during follow-up were determined.

Results:

A total of 218 treatment-naïve patients were included, with a median follow-up of 4.48 years. Respectively, 190 (87.2%), 160 (73.4%), 148 (67.9%), 94 (43.1%), 23 (10.6%) and 18 (8.3%) patients achieved LLDAS, LLDAS5, clinical RONT, complete RONT, clinical ROFT and complete ROFT at least once during the follow-up time. The median time to LLDAS, LLDAS5, clinical RONT and complete RONT were 1.4, 2.3, 2.6 and 4.7 years, respectively.

Table 1.

Frequencies, time to achieve and annual cumulative probabilities of each state by Kaplan-Meier approach

StatesAchieved patientsNumber (%)Time to achieve(years)Cumulative probabilities of achievement (%)Year 1Year 2Year 3Year 4Year 5LLDAS190 (87.2)1.418.869.786.789.192.6LLDAS5160 (73.4)2.36.940.763.376.082.3Clinical RONT148 (67.9)2.65.536.156.168.876.6Complete RONT94 (43.1)4.74.122.637.545.350.4Clinical ROFT23 (10.6)NA1.42.95.46.710.6Complete ROFT18 (8.3)NA0.92.54.84.88.8Table 2.

Patients who achieved each component of LLDAS or DORIS during follow-up

ComponentsNumber (%)SLEDAI-2K ≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever), and no haemolytic anaemia or gastrointestinal active213 (97.7)Clinical SLEDAI-2K =0210 (96.3)PGA ≤1217 (99.5)PGA <0.5199 (91.3)Serology (anti-dsDNA and complement) negative148 (67.9)Prednisone dose ≤7.5 mg/day201 (92.2)Prednisone dose ≤5 mg/day171 (78.4)No prednisone dose40 (18.3)No prednisone dose and Immunosuppressants32 (14.7)

Conclusion:

Our data confirmed that LLDAS is an attainable early treatment target for SLE. Though with more difficulty, RONT can be achieved in two-thirds of our patients. ROFT may not be an ideal treatment target at present as it is only attained in few patients.

References:

[1]Franklyn, K. et al. Ann Rheum Dis. 2016 Sep;75(9):1615-21.

[2]van Vollenhoven, R. et al. Ann Rheum Dis. 2017 Mar;76(3):554-561.

Disclosure of Interests:

None declared

AB0376 DETERMINANTS AND PROTECTIVE EFFECTS OF A LOW DISEASE ACTIVITY STATE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT

Background:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts.

Objectives:

The concept of treat to target in systemic lupus erythematosus has moved forward in recent years. The Lupus low disease activity state (LLDAS) defined by the Asia-Pacific Lupus Collaboration (APLC) in 2016 has been validated prospectively in the APLC cohort itself and retrospectively in multiple other cohorts. The aim of this study was to investigate the frequency and determinants of achieving LLDAS, and the influence of LLDAS on short term outcomes including disease flare and damage accrual in Chinese lupus patients.

Methods:

The baseline and follow-up data of all consecutive patients in a longitudinal lupus cohort from January 2017 to December 2018 were collected prospectively. SLEDAI-2K, PGA and disease flare were assessed at each follow-up visit, and further compared to the previous routine clinical visits. Irreversible disease damage was captured using the SLICC damage index and the short form (36) health survey for health-related quality of life was completed annually.

Results:

One hundred and forty-nine patients were enrolled, with the median disease duration at recruitment of 2.4 (0.9–8.2) years, and median follow-up of 15.4 (10.1-18.2) months. By the end of the study, 104 (69.8%) patients achieved LLDAS at least once; 59 patients achieved LLDAS for≥50% of observations. Multivariate logistic regression analysis showed that age at disease onset< 30 years (OR=0.05, 95%CI [0.01-0.59], p=0.017), 24-hour urine total protein (UTP) level at recruitment (OR=0.9992, 95%CI [0.9987-0.9998], p=0.007), and C3 level (OR=1.004, 95%CI [1.001-1.008], p=0.024) had independent associations with achieving LLDAS for≥50% of all observations (Table 1). During follow-up, 56 (37.6%) patients experienced disease flare including 14 (9.4%) patients with severe flare. Kaplan-Meier analyses showed significant differences in flare rates according to whether LLDAS was achieved and the percentage follow-up time in LLDAS (Figure 1). Multivariate cox analysis revealed that the percentage time of time in LLDAS was an independent negative determinant of disease flare (HR=0.18, 95% CI [0.07-0.48], p=0.001) (Table 2). There were 16 (15.0%)/107 patients who had damage accrual after one year of follow-up. Multivariate logistic analysis showed a tendency for achieving LLDAS during follow-up being protective for damage accrual (OR=0.27, 95%CI [0.07-1.00], p=0.050).

Conclusion:

In this Chinese early disease cohort, LLDAS was an attainable goal in clinical practice. Age at onset, UTP and C3 level at recruitment influenced achievement of LLDAS. LLDAS was negatively associated with disease flare and damage accrual; this needs to be confirmed by future longer follow-up.

Acknowledgments:

The data in this cohort was collected and recorded using the framework of the lupus low disease activity status (LLDAS) study from the Asia-Pacific Lupus Collaboration (APLC).

Disclosure of Interests:

Yanjie Hao: None declared, Lanlan Ji: None declared, Dai Gao: None declared, Yong Fan: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Consultant of: AstraZeneca, Speakers bureau: AstraZeneca, Mandana Nikpour: None declared, Zhuoli Zhang: None declared

SAT0096 DISCORDANCE BETWEEN SUBJECTIVE AND OBJECTIVE INDEX OF THE DISEASE ACTIVITY SCORE MAY REDUCE THE CORRELATION BETWEEN CLINICAL AND ULTRASOUND ASSESSMENT IN RHEUMATOID ARTHRITIS

Background:

There was discordance between subjective and objective index of the disease activity score, or between clinical parameters and ultrasound findings in some RA patients. Therefore, we set out to determine whether the discordance between subjective and objective index of the composite score could reduce the correlation between clinical and ultrasound parameters in RA.

Objectives:

To investigate whether the discordance between tender and swollen joint count (TJC and SJC) as well as patient’s and evaluator’s global assessment (PGA and EGA) influences the correlation between clinical and US parameters in RA.

Methods:

RA patients with available ultrasonography of 28 joints from Jan 2014 to Jan 2018 were enrolled in the study. Gray-scale (GS) synovial hypertrophy and Power Doppler (PD) synovitis were measured and semi-quantitatively graded. The total GS/PD score was the sum score of 28 joints. SJC and TJC based on 28 joints, PGA and EGA of all the patients were evaluated by one rheumatologist. The numeric difference between TJC and SJC (ΔTSJ) and that between PGA and EGA (ΔPEG) were calculated. The correlation between clinical and ultrasound parameters in different ΔTSJ and ΔPEG subgroups was explored.

Results:

Totally 163 patients were enrolled in the study. Clinical composite disease activity scores and all the components were significantly correlated with the total GS and PD scores (p<0.01 for all). But the relevance between the clinical disease parameters and total PD score became weak, with the increase of ΔTSJ. For the patients with ΔTSJ > 5, the total PD score was only correlated with CRP, EGA and PGA, while the total GS score was only correlated with CRP. Similarly, no correlation between total PD score and clinical parameters, except for SJC, was observed in patients with ΔPEG < 0 (p < 0.05).

Conclusion:

Total PD/GS score was correlated well with the clinical parameters of disease activity, including both the subjective and objective indexes. But for patients with ΔTSJ > 5,there was no correlation between total GS/PD scores and clinical composite disease activity scores, except that only the objective index (CRP, SJC and EGA) were more likely to correlate with total GS/PD scores.

Disclosure of Interests:

None declared

THU0247 FREQUENCY AND PREDICTORS OF THE LUPUS LOW DISEASE ACTIVITY STATE IN CHINESE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: AN OBSERVATIONAL COHORT STUDY

Background:

As a consensus-based definition of minimally acceptable disease activity in systemic lupus erythematosus (SLE), Lupus Low Disease Activity State (LLDAS) has been well-validated and widely accepted. However, no data about the time to LLDAS in Asian ethnicity has been reported so far.

Objectives:

To estimate the time to LLDAS and the predictors of time to LLDAS in our prospective observational cohort of Chinese patients with SLE.

Methods:

Patients were from Peking University First Hospital SLE cohort and those having not fulfilled LLDAS at enrolment were included in this study. The time to LLDAS and annual cumulative probabilities of LLDAS achievement were estimated by the Kaplan-Meier approach. The predictors of time to LLDAS were identified by univariate and multivariable Cox proportional hazards.

Results:

A total of 574 patients with SLE were included and 435 (75.8%) of them achieved LLDAS during a median 4.2 years of follow-up. The median time to LLDAS was 19.0 months and the cumulative probabilities at 1, 2, 3, 5 and 10 years were 19.8%, 57.6%, 72.0%, 85.1% and 98.0%, respectively. In multivariable Cox models, older age at disease onset, treatment-naïve and hydroxychloroquine prescription were found to be independent predictors of shorter time to LLDAS, after adjusted by daily prednisone dose, SLE Disease Activity Index 2000 and physician’s global assessment. Finally, we developed a matrix model based on the identified independent predictors to present the time to LLDAS in patients with respective characteristics.

Conclusion:

Our study proved that LLDAS is attainable as an early treatment target for SLE in Chinese patients. The older age at disease onset, treatment-naïve and hydroxychloroquine prescription were independent predictors of shorter time to LLDAS.

References:

[1]Franklyn K, Lau CS, Navarra SV, Louthrenoo W, Lateef A, Hamijoyo L, Wahono CS, Chen SL, Jin O, Morton S, Hoi A, Huq M, Nikpour M, Morand EF; Asia-Pacific Lupus Collaboration. Ann Rheum Dis. 2016 Sep;75(9):1615-21.

Table 1

Baseline variables associated with LLDAS achievement based on multivariable Cox models

CharacteristicsModel 1Model 2Model 3HR (95% CI)pvalueHR (95% CI)pvalueHR (95% CI)pvalueAge at disease onset, years1.010 (1.003-1.016)0.0051.009 (1.002-1.016)0.0101.010 (1.003-1.017)0.004Treatment-naïve1.346 (1.105-1.641)0.0031.425 (1.161-1.749)0.0011.484 (1.204-1.830)<0.001Nephritis0.776 (0.641-0.939)0.0091.066 (0.820-1.385)0.6340.925 (0.737-1.160)0.498SLEDAI0.968 (0.950-0.987)0.001PGA0.685 (0.551-0.853)0.001Daily prednisone (or equivalent) dose, mg/d1.003 (0.998-1.007)0.2661.005 (0.999-1.010)0.093HCQ1.638 (1.263-2.123)<0.0011.713 (1.318-2.225)<0.0011.664 (1.284-2.157)<0.001

Disclosure of Interests:

None declared

Effect of GATA4 gene methylation on proliferation and apoptosis of SGC-7901 gastric cancer cells

Gastric cancer (GC) remains a major cause of cancer-related deaths worldwide. GATA4 has been previously reported to exhibit functions in GC. In this study, we aimed to investigate the effect of GATA4 gene methylation on GC progression. Methylation-Sensitive High-Resolution Melting was used to detect the methylation of GATA4 promoter region in GC tissues and adjacent normal tissues, GC cell lines and GES-1 cells. The relationship between GATA4 methylation level and clinical characteristics of GC patients was analyzed. GATA4 levels in GC tissues and adjacent normal tissues, GC cell lines and GES-1 cell lines were detected, and gain-of-function was performed to investigate the role of GATA4 in GC. si-GATA4 was transfected into GES-1 cells to observe the changes of various indicators. RNA-seq detected the differentially expressed genes in SGC-7901 cells overexpressing GATA4, and western blot analysis verified their expression. GATA4 methylation rate was increased in GC tissues, and GATA4 promoter was abnormally methylated in GC cells. GATA4 methylation rate in GC tissues was related to lymph node metastasis, differentiation degree and clinical stage of GC patients. Lower expressed GATA4 was observed in GC tissues and cells. Cell proliferation rate decreased and cell apoptosis rate increased in SGC-7901 cells overexpressing GATA4. Transfecting si-GATA4 into GES-1 cells led to increased proliferation, inhibited apoptosis, and restoration of GATA4 led to decreased APC and GSK3β levels. In conclusion, restoration of GATA4 caused by 5-Aza treatment can inhibit the proliferation and promote apoptosis of GC cells possibly via Wnt/β-catenin signaling pathway. This study may offer new sight for GC treatment.

Factors associated with resistance to complications in long-standing type 1 diabetes in China

OBJECTIVE

Type 1 diabetes (T1DM) is associated with a higher risk of premature death, but there are factors in certain patients with T1DM that protect them from complications and premature death. These factors had not been identified in non-Caucasian populations, so we aimed to identify factors that protect against the development of diabetic nephropathy (DN) and diabetic retinopathy (DR) in long-standing T1DM in China

METHODS

Ninety-five T1DM patients with >30 years’ duration of diabetes were enrolled in this nationwide study. Differences between groups of patients with and without complications were compared, and multivariable regression analysis was used to evaluate the relationships between candidate protective factors and the development of DN or DR.

RESULTS

Thirty of the participants did not have DN and the same amount did not have DR. 6/52 of participants without DN were from a rural area, whereas 11/28 of participants with DN had been born in a rural area (P = 0.005). Systolic blood pressure (SBP) was higher in participants with DN (135 ± 26 mmHg vs 121 ± 13 mmHg; P = 0.002). In participants without DR, 27/30 were married or cohabitating, and only 3/30 were single, never married, or widowed, but for those with proliferative DR (PDR), 13/26 had been married (P = 0.003). A rural or urban origin and SBP were associated with DN in the multivariable analysis.

CONCLUSION

we have shown that higher socioeconomic status, indicated by birth in an urban area, and being married or cohabitating, are accompanied by better blood pressure control and a lower risk of microvascular complications in Chinese patients with long-standing T1DM. These findings illustrate the importance of improving care for patients with T1DM in China.

[Application of double skin island free forearm flap in the repair of large perforating defect of palate]

Objective:To explore the value of free forearm flap with double skin island in repairing large perforating defect of palate. Method:The free forearm flap with double skin island was used to repair 6 cases of large perforating palatal defect due to oral malignant tumor. Preoperative Allen test and ultrasound doppler examination were used to judge the forearm vessels. Result:All the free forearm flap with double skin island survived in 6 cases, followed up for 3 months to 24 months, the patients ate normally, swallowing without nasal regurgitation. The patients had mild to moderate nasal sounds, and the patients were satisfied with the effect of operation and the quality of life. Conclusion:The double skin island free forearm flap is a reliable method for repairing large perforating defect of palate, with satisfactory morphological function and good effect.

Protection from noise-induced cochlear synaptopathy by virally mediated overexpression of NT3

Noise exposures causing only transient threshold shifts can destroy auditory-nerve synapses without damaging hair cells. Here, we asked whether virally mediated neurotrophin3 (NT3) overexpression can repair this damage. CBA/CaJ mice at 6 wks were injected unilaterally with adeno-associated virus (AAV) containing either NT3 or GFP genes, via the posterior semicircular canal, 3 wks prior to, or 5 hrs after, noise exposure. Controls included exposed animals receiving vehicle only, and unexposed animals receiving virus. Thresholds were measured 2 wks post-exposure, just before cochleas were harvested for histological analysis. In separate virus-injected animals, unexposed cochleas were extracted for qRT-PCR. The GFP reporter showed that inner hair cells (IHCs) were transfected throughout the cochlea, and outer hair cells mainly in the apex. qRT-PCR showed 4- to 10-fold overexpression of NT3 from 1–21 days post-injection, and 1.7-fold overexpression at 40 days. AAV-NT3 delivered prior to noise exposure produced a dose-dependent reduction of synaptopathy, with nearly complete rescue at some cochlear locations. In unexposed ears, NT3 overexpression did not affect thresholds, however GFP overexpression caused IHC loss. In exposed ears, NT3 overexpression increased permanent threshold shifts. Thus, although NT3 overexpression can minimize noise-induced synaptic damage, the forced overexpression may be harmful to hair cells themselves during cochlear overstimulation.

High prevalence of norovirus GII.P16/GII.2 and chicken anemia virus in two acute gastroenteritis outbreaks in Huzhou, China

Acute gastroenteritis (AGE) is one of the most frequently occuring illnesses in children and adults worldwide. In February 2017, two AGE outbreaks occurred in two adjacent schools in Huzhou city, Zhenjiang province of China. We detected high percentages of recombinant norovirus GII.P16/GII.2 in one school and chicken anemia virus (CAV) in another school using next generation sequencing (NGS) and specific PCR. The results highlight the importance of continuous surveillance of GII.P16/GII.2, and suggest the need of further studies on whether CAV causes AGE. Keywords: acute gastroenteritis; norovirus; chicken anemia virus; Huzhou; School.

Nephroprotective effect of wogonin against cadmium-induced nephrotoxicity via inhibition of oxidative stress-induced MAPK and NF-kB pathway in Sprague Dawley rats

Oxidative stress (OS) is one of the responsible factors for causing renal diseases. For the treatment or prevention of the renal disease, antioxidants use could be a hopeful therapeutic mediation as they block the oxidative reaction along with inflammatory process. Wogonin (Wog) is a plant flavonoid, a pharmacologically active component of Scutellaria baicalensis Georgi (Huang Qui), which exhibits antioxidant activity. In this investigation, we explored the nephroprotective activity of Wog on cadmium (Cd)-induced nephron toxicity in rats. Administering (10 and 20 mg/kg) intraperitoneally diminished Cd-induced anomalies in kidney histology and creatinine and serum urea levels. Wog therapy reduced the Cd-influenced generation of inflammatory mediators, inclusive of tumor necrosis factor alpha, interleukin 6, and interleukin 1 beta. Western blot analysis demonstrated that Wog abolished proinflammatory nuclear factor-kappa B (NF-κB) p65 stimulation, phosphorylation of p38 mitogen-activated protein kinases (MAPKs). In all, Wog demonstrated antioxidative and anti-inflammatory effects in Cd- intoxicated rats by obstructing OS and activation of NF-κB via restricting the stimulation of upstream kinases inclusive of MAPKs.

PlexinA2 Forward Signaling through Rap1 GTPases Regulates Dentate Gyrus Development and Schizophrenia-like Behaviors

Dentate gyrus (DG) development requires specification of granule cell (GC) progenitors in the hippocampal neuroepithelium, as well as their proliferation and migration into the primordial DG. We identify the Plexin family members Plxna2 and Plxna4 as important regulators of DG development. Distribution of immature GCs is regulated by Sema5A signaling through PlxnA2 and requires a functional PlxnA2 GTPase-activating protein (GAP) domain and Rap1 small GTPases. In adult Plxna2^−/− but not Plxna2-GAP-deficient mice, the dentate GC layer is severely malformed, neurogenesis is compromised, and mossy fibers form aberrant synaptic boutons within CA3. Behavioral studies with Plxna2^−/− mice revealed deficits in associative learning, sociability, and sensorimotor gating—traits commonly observed in neuropsychiatric disorder. Remarkably, while morphological defects are minimal in Plxna2-GAP-deficient brains, defects in fear memory and sensorimotor gating persist. Since allelic variants of human PLXNA2 and RAP1 associate with schizophrenia, our studies identify a biochemical pathway important for brain development and mental health.

Synaptopathy as a Mechanism for Age-Related Vestibular Dysfunction in Mice

Age-related decline of inner ear function contributes to both hearing loss and balance disorders, which lead to impaired quality of life and falls that can result in injury and even death. The cellular mechanisms responsible for the ear's functional decline have been controversial, but hair cell loss has been considered the key cause for a long time. However, recent studies showed that in the cochlea, loss of inner hair cell (IHC) synapses precedes hair cell or neuronal loss, and this synaptopathy is an early step in the functional decline. Whether a similar process occurs in the vestibular organ, its timing and its relationship to organ dysfunction remained unknown. We compared the time course of age-related deterioration in vestibular and cochlear functions in mice as well as characterized the age-associated changes in their utricles at the histological level. We found that in the mouse, as in humans, age-related decline in vestibular evoked potentials (VsEPs) occurs later than hearing loss. As in the cochlea, deterioration of VsEPs correlates with the loss of utricular ribbon synapses but not hair cells or neuronal cell bodies. Furthermore, the age-related synaptic loss is restricted to calyceal innervations in the utricular extrastriolar region. Hence, our findings suggest that loss of extrastriolar calyceal synapses has a key role in age-related vestibular dysfunction (ARVD).

Auditory metabolomics, an approach to identify acute molecular effects of noise trauma

Animal-based studies have provided important insights into the structural and functional consequences of noise exposure on the cochlea. Yet, less is known about the molecular mechanisms by which noise induces cochlear damage, particularly at relatively low exposure levels. While there is ample evidence that noise exposure leads to changes in inner ear metabolism, the specific effects of noise exposure on the cochlear metabolome are poorly understood. In this study we applied liquid chromatography-coupled tandem mass spectrometry (LC-MS/MS)-based metabolomics to analyze the effects of noise on the mouse inner ear. Mice were exposed to noise that induces temporary threshold shifts, synaptopathy and permanent hidden hearing loss. Inner ears were harvested immediately after exposure and analyzed by targeted metabolomics for the relative abundance of 220 metabolites across the major metabolic pathways in central carbon metabolism. We identified 40 metabolites differentially affected by noise. Our approach detected novel noise-modulated metabolites and pathways, as well as some already linked to noise exposure or cochlear function such as neurotransmission and oxidative stress. Furthermore, it showed that metabolic effects of noise on the inner ear depend on the intensity and duration of exposure. Collectively, our results illustrate that metabolomics provides a powerful approach for the characterization of inner ear metabolites affected by auditory trauma. This type of information could lead to the identification of drug targets and novel therapies for noise-induced hearing loss.

A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis

<sec> <title>SETTING</title> The proportion of bacteriologically confirmed tuberculosis (TB) in China has decreased far below the worldwide average. </sec> <sec> <title>OBJECTIVE</title> To investigate whether stepwise measures to ensure sputum quality can improve the rate of bacteriologically confirmed TB. </sec> <sec> <title>DESIGN</title> We enrolled 980 adults with suspected TB from three counties in China during 2017 for this multicentre randomised controlled trial. Half the participants (n = 490) were randomly assigned to intervention groups that received instructions by a study nurse, and sputum induction, if necessary. In the remaining 490 patients, sputum samples were collected without observation. The primary outcome was the proportion of patients detected as bacteriologically positive on smear, culture or molecular assays (EasyNAT or Xpert). </sec> <sec> <title>RESULTS</title> Bacteriological confirmation rates were significantly higher in the intervention than in the control group: overall (159/490 [32%] vs. 122/490 [25%]; P = 0.009); confirmation using smear (17% vs. 11%; P = 0.010); confirmation using culture (28% vs. 21%; P = 0.021); and confirmation using molecular assays (27% vs. 18%; P = 0.001). Most of the improvement was in patients who received instruction alone, while improvement was greatest in younger patients (adjusted odds ratio 1.27, 95%CI 1.05-1.53 per 10 years). </sec> <sec> <title>CONCLUSIONS</title> If implemented effectively in resource-limited primary care clinics, our simple stepwise procedure combining instruction and sputum induction could increase the proportion of bacteriologically confirmed TB significantly. </sec>.

Cytotoxic effect of oxaloacetate on HepG2-human hepatic carcinoma cells via apoptosis and ROS accumulation

Oxaloacetate (OA) is one of the intermediates of the Krebs cycle. In addition to its role in energy production, OA may have other effects on the cell. We report here that OA could have a cell type dependent cytotoxic effect on the human hepatic carcinoma cell line HepG2 through induction of apoptosis and reactive oxygen species (ROS) accumulation. In our study, OA decreased the viability and colony formation of HepG2 cells and induced cell death. Caspase-3 activity was increased, the pro-apoptotic protein Bax was up-regulated, and the anti-apoptotic protein Bcl-2 was down-regulated in OA-treated HepG2 cells indicating that apoptosis through the intrinsic pathway was involved in the cell death. The ROS level in OA-treated HepG2 cells was increased. The anti-oxidant N-acetylcysteine (NAC) and glutathione (GSH) prevented the OA-induced decrease in cell but did not alter the enhanced apoptotic Bax/Bcl-2 mRNA ratio. These results suggest that the OA-induced apoptosis of HepG2 cell is not driven by oxidative damage and at least two distinct mechanisms, one mediated by ROS and one involving apoptosis, result in the cytotoxic effects of OA on HepG2 cells. These studies expand the biological functional repertoire of OA and provide a mechanism by which hepatocellular carcinoma may be targeted by OA.

Abstract P4-13-10: The outcome of lung metastasis treated with fulvestrant is superior to that of liver metastasis for metastatic breast cancer

Background: Endocrine therapy is the preferred option in patients presenting with hormone receptor (HR)-positive metastatic breast cancer (MBC). While visceral metastasis is a negative prognostic factor, few studies have distinguished between the prognosis of different visceral sites.

Patients and methods: 505 HR-positive MBC patients administered with fulvestrant at Fudan University Shanghai Cancer Center during a 6-year period were enrolled, 398 patients receiving fulvestrant 500mg were included in final analysis. Logistic regression models were used to identify prognostic factors associated with progression-free survival (PFS). Kaplan-Meier analysis was utilized to compare PFS of lung and liver metastases.

Results: Median follow-up time was 26 months. 233 patients presented with baseline visceral metastases, including 138 lungw/o liver metastases (lung metastasis without liver involvement), 51 liverw/o lung metastases (liver metastasis without lung involvement), and 41 with both lung and liver metastases. Median PFS was 6.8 months (5.6 months for visceral metastases, 9.2 months for non-visceral metastases, P = 0.028). Lungw/o liver metastases had longer median PFS compared to liverw/o lung metastases or both lung and liver metastases (9.6 months, 3.7 months and 3.2 months, respectively, P &lt; 0.001). In addition, patients with liver metastases experienced a significantly worse PFS when compared with those without liver involvement (3.7 versus 9.2 months, P &lt; 0.001). In multivariate analyses, PFS benefits of fulvestrant were observed in patients with longer disease-free interval, absence of liver metastases, and no previous chemotherapy for MBC.

Table 1.Univariate and multivariate analysis of progression-free-survival by prespecified stratification factors.VariablesN Univariate  Multivariate   Mediana95% CIPHR95% CIPMenopausal status       Premenopausal8411.06.4-15.7 ---Postmenopausal3145.94.7-7.10.052---Disease-free interval       &gt; 5 y1818.65.8-11.5 1  ≤ 5 y1714.83.6-6.00.0031.421.01-1.990.043PgR status       Positive2856.95.3-8.6 ---Negative + UK1135.54.6-6.30.107---Bone-only metastasis       Yes6110.92.7-19.0 1  No3375.84.8-6.80.0021.690.91-2.800.06Metastatic sites       Non-visceral1659.26.7-11.7 1  Lungw/o liver1389.65.3-13.90.860---Liver923.72.9-4.5&lt;0.0011.511.05-2.180.027ET naïve       Yes3226.8NE-59.3 1  No3666.04.9-7.20.012.120.99-4.540.052Prior ET for metastatic disease       014511.05.5-16.6 1  ≥12535.64.9-6.30.0020.910.62-1.340.645Sensitivity to prior ET       Primary resistance714.02.9-5.0 ---Secondary resistance2957.05.6-8.30.05---Prior chemotherapy for metastatic disease       02039.96.5-13.2 1  ≥11954.73.9-5.5&lt;0.0011.931.32-2.820.001Abbreviations: PgR, progesterone receptor; UK, unknown; HR, hazard ratio; 95% CI, 95% confidence interval; ET, endocrine therapy; NE, not estimable. Lungw/o liver, lung metastasis without liver involvement. aMedian PFS in months. P &lt; 0.05 was considered significant, significant values was presented in bold.

Conclusion: Patients with lungw/o liver metastases benefit as well as those with non-visceral metastases from fulvestrant. Visceral metastases should distinguish between liver or lung when treating HR-positive/HER2-negative MBC with endocrine therapy.

Citation Format: He M, Li J-J, Zuo W-J, Ji L, Hu X-C, Wang Z-H, Shao Z-M. The outcome of lung metastasis treated with fulvestrant is superior to that of liver metastasis for metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-10.

Aging and the peripheral vestibular system

Whereas much has been learned about age-related auditory changes in the inner ear, relatively little is known about the aging effects on the vestibular part of the inner ear-the peripheral vestibular system. Here we review relevant literature with regard to the prevalence of vestibular dysfunction, vestibular functional and structural changes in the elderly. The prevalence of vestibular dysfunction increases with age. Functionally, as age increases, VEMP amplitudes decrease, VEMP thresholds increase, VOR gain of HIT decreases. Due to the complexity of the vestibular system, variations in subject age and measurement techniques, findings in VEMP latency and caloric tests are conflicting. To address this, a direct measure of the peripheral vestibular system should be applied. Structurally, age-related loss in vestibular ganglion and otoconia have been noted; hair cell changes are not well defined; while subcellular changes remain to be explored. Defining how the onset of vestibular dysfunction correlates with structural degeneration will offer insights into the mechanisms underlying vestibular aging.

Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study

OBJECTIVE

To evaluate the subsequent rate of thrombosis among women with obstetric antiphospholipid syndrome (Ob-APS) in a multicentre database of antiphospholipid antibody (aPL)-positive patients, and the clinical utility of the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), a validated tool to assess the likelihood of developing new thrombosis, in this group of patients.

DESIGN

Retrospective study.

SETTING

The Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository.

POPULATION

Women with Ob-APS.

METHODS

Comparison of clinical and laboratory characteristics and measurement of aGAPSS in women with Ob-APS, with or without thrombosis, after initial pregnancy morbidity (PM).

MAIN OUTCOME MEASURES

Risk factors for thrombosis and aGAPSS.

RESULTS

Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented with thrombosis, and 47 (63%) of these women developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age at diagnosis of Ob-APS, additional cardiovascular risk factors, superficial vein thrombosis, heart valve disease, and multiple aPL positivity increased the risk of first thrombosis after PM. Women with thrombosis after PM had a higher aGAPSS compared with women with Ob-APS alone [median 11.5 (4-16) versus 9 (4-13); P = 0.0089].

CONCLUSION

Based on a retrospective analysis of our multicentre aPL database, 63% of women with Ob-APS developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased the risk. Women with subsequent thrombosis after Ob-APS had a higher aGAPSS at entry to the registry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women.

TWEETABLE ABSTRACT

More than 60% of women with obstetric antiphospholipid syndrome had thrombosis after initial pregnancy morbidity.

Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus

Objectives

To investigate the mortality and causes of death in Chinese patients with systemic lupus erythematosus.

Methods

We collected the clinical data of all consecutive adult systemic lupus erythematosus patients at the Rheumatology department of Peking University First Hospital between January 2007 and December 2015. The primary causes of death were identified, the standardized mortality ratio and years of life lost were calculated, and the survival and variables associated with mortality were determined by Kaplan–Meier and Cox regression analysis respectively.

Results

The mean age of all 911 patients (814 females and 97 males) was 37.8 ± 14.7 years, the median disease duration at recruitment was 2.6 (0.5–7.0) years, and the median follow-up duration was 3.0 (1.4–5.1) years. Among the 911 patients who were successfully followed up, 45 patients died. Infection (31.1%) was the leading cause of death followed by renal failure, pulmonary arterial hypertension and cerebrovascular diseases. The overall age and sex-adjusted standardized mortality ratio was 3.2 (95% confidence interval 2.4–4.0), and the years of life lost for women and men were 29.8 and 9.4 respectively. Overall survival at 1, 5 and 10 years was 98.2%, 95.3% and 93.7% respectively. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were independent risk factors for the mortality of systemic lupus erythematosus patients, and longer disease duration at recruitment was an independent protective factor.

Conclusions

Mortality of systemic lupus erythematosus patients in China was substantial, especially in females, with infection the leading cause of death. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were associated with poor outcomes.

Age distribution and metabolic disorders in people with Type 1 diabetes in Beijing and Shantou, China: a cross-sectional study

AIMS

To examine whether the age profile of people with Type 1 diabetes differs from that of the general population and in what manner, and to study the clinical characteristics related to metabolic disorders among people with Type 1 diabetes in China.

METHODS

We sequentially enrolled 849 people with Type 1 diabetes from hospital records review, inpatient wards and outpatient clinics. Data were collected via face-to-face interviews, medical records and venous blood samples. Beijing census data for 2011 were used to provide the general population statistics. Descriptive analysis of the results and tests for differences were performed.

RESULTS

The median (interquartile range) age at diagnosis of diabetes was 16 (9-28) years and the duration of diabetes was 4 (1-8) years. The mean ± sd HbA_1c concentration was 76±28 mmol/mol (9.1±2.5%). Compared with the general population, the population with Type 1 diabetes comprised more young individuals and fewer elderly individuals. The overall prevalence of metabolic syndrome among those with Type 1 diabetes was 10.1% (95% CI 7.9-12.2). People with metabolic syndrome were older and were diagnosed with diabetes at an older age. Hypertension and dyslipidaemia were more common in obese individuals with Type 1 diabetes than in their non-obese counterparts.

CONCLUSIONS

Compared with the general population, people with Type 1 diabetes comprised more young and fewer elderly individuals. The prevalence of metabolic syndrome in the Type 1 diabetes population was 10.1%. Hypertension and dyslipidaemia were more prevalent in obese than non-obese individuals.

Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries

AIMS

To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries.

METHODS

People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected.

RESULTS

A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0-29.6%).

CONCLUSIONS

Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes.