[A prospective cohort study on socioeconomic status and risk of all-cause mortality among patients with type 2 diabetes based on latent class analysis]

Objective: To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area. Results: Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively. Conclusions: Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations.

Deep Underground Laboratory Measurement of ^{13}C(α,n)^{16}O in the Gamow Windows of the s and i Processes

The ^{13}C(α,n)^{16}O reaction is the main neutron source for the slow-neutron-capture process in asymptotic giant branch stars and for the intermediate process. Direct measurements at astrophysical energies in above-ground laboratories are hindered by the extremely small cross sections and vast cosmic-ray-induced background. We performed the first consistent direct measurement in the range of E_{c.m.}=0.24 to 1.9 MeV using the accelerators at the China Jinping Underground Laboratory and Sichuan University. Our measurement covers almost the entire intermediate process Gamow window in which the large uncertainty of the previous experiments has been reduced from 60% down to 15%, eliminates the large systematic uncertainty in the extrapolation arising from the inconsistency of existing datasets, and provides a more reliable reaction rate for the studies of the slow-neutron-capture and intermediate processes along with the first direct determination of the alpha strength for the near-threshold state.

Defining blood gas analysis stability limits across five sample types

Accurate reporting of blood gas samples is dependent upon following proper preanalytical sample handling requirements though there is variation for sample acceptability criteria across institutions. We examined five common sample types (arterial, venous, umbilical arterial, umbilical venous and capillary) stored at either room temperature or on crushed ice in a time series (0, 15, 30, 45, 60, 90, 180, 240 min) and applied local regulatory and/or institutional allowable performance limits to determine the need for cold preservation and/or maximum stability time for pH, pO₂, pCO₂, glucose, lactate, sodium, potassium, chloride, and ionized calcium where applicable in each sample type. Although changes in sample pO₂ and/or lactate values were responsible, in part or in whole, for surpassing the allowable limits in nearly all sample types analyzed, this was not uniformly observed across sample types within the typical time limits that are referenced in literature. Furthermore, we demonstrated that cold preservation may not ubiquitously provide longer stability for blood gas specimens and this is dependent on the sample type and analyte in question. Nevertheless, these results demonstrate the known instability of pO₂ and lactate and suggest that it may be possible to simplify the monitoring of preanalytical conditions by first evaluating pO₂ and lactate in patient blood gas samples if applicable.

Self-compression of stimulated Raman backscattering by a flying focus

The regime of self-compression has been proposed for plasma-based backward Raman amplification upon a flying focus. By using a pumping focus moving with a speed equal to the group velocity of stimulated Raman backscattering (SRBS), only a short part of SRBS which always synchronizes with the flying focus can be amplified. Therefore, instead of a short pulse, plasma noise or a long pulse can seed the BRA amplifiers. Here we demonstrate the regime by 2D particle-in-cell simulations, showing that the pump pulse is compressed from 26 ps to 116 fs, with an output amplitude comparable with the case of a well-synchronized short seed. As only one laser pulse is used in the simulation, the results present a significant path to simplify the Raman amplifiers.

[Application of immunohistochemical staining of PRAME in differential diagnosis between melanoma and melanocytic nevus]

Objective: To investigate the diagnostic value of preferentially expressed antigen in melanoma (PRAME) in differential diagnosis of benign and malignant cutaneous melanocytic lesions. Methods: Fifty-nine cases of melanoma (50 cases of skin primary melanoma, and 9 cases of metastatic melanoma) and 48 cases of melanocytic nevus (40 cases of common nevus and 8 cases of dysplastic nevus) were subject to PRAME immunohistochemistry staining.The difference of PRAME expression between melanoma and melanocytic nevus was analyzed. Results: Among the 50 patients with primary cutaneous melanoma, there were 23 males and 27 females ranging in age from 33 to 87 years (average age 62.4 years, median age 64.5 years). Among the 9 metastatic melanoma there were 7 males and 2 females ranging in age from 40 to 82 years (average age 64 years, median age 65 years). Twenty-six cases (26/50, 52.0%) of cutaneous primary melanoma and 4 cases (4/9) of metastatic melanoma showed diffuse positive PRAME staining. 40 cases (40/40, 100%) of common nevus and 8 (8/8) cases of dysplastic nevus were PRAME negative. Compared with melanocytic nevus group, the melanoma group included more cases with diffuse positive PRAME staining (P<0.05). The sensitivity and specificity of using PRAME to differentiate primary cutaneous melanoma from melanocytic nevus in the cohort is 52.0% and 100%. Conclusions: There is a significant difference in the expression of PRAME between melanoma and melanocytic nevus.Thus, PRAME can be used as an auxiliary diagnostic tool for differentiating benign from malignant cutaneous lesions.

POS0740 IMPACT OF TIME TO REMISSION, FLARES AND EXPOSURE TO IMMUNOSUPPRESSIVES ON THE DEVELOPMENT OF ADVANCED CHRONIC KIDNEY DISEASE (STAGE IV OR WORSE) IN LUPUS NEPHRITIS

Background

Lupus nephritis (LN) affects up to 40% of patients with SLE and leads to end stage kidney disease (ESKD) in 17-33% after 10 years. The prevalence of chronic kidney disease stage IV (estimated glomerular filtration rate, eGFR=15-29ml/min/1.73m2) is not known; however, approximately two thirds of such patients will progress to ESKD after 6 years on average.1

Objectives

To determine the impact of time to remission and flares on the development of advanced CKD (stage IV or worse) in LN.

Methods

Patients with LN based on biopsy or abnormal proteinuria (>0.5g/day) with or without hematuria/pyuria/casts for two consecutive visits in the absence of other plausible explanation were retrieved from the Toronto Lupus Clinic database. Individuals with advanced CKD at baseline were excluded. All patients were followed for at least 5 years. The primary outcome was the development of advanced CKD (eGFR≦29ml/min/1.73m2). Remission was defined as proteinuria<0.5g/24h, no active urinary sediment and serum creatinine of ≤120% of baseline. Flare was defined as any abnormal proteinuria (>0.5g/day) after remission. Death was treated as competing risk in survival analysis. Statistical analysis with SAS 9.4; p<0.05 was considered significant.

Results

Out of 418 eligible patients, 209 (50%) achieved remission within the first year from LN diagnosis, 102 (24.4%) within the 2nd and 3rd years, 70 (16.7%) after 3 years and 37 (8.9%) never achieved remission. Sixty-six patients (15.8%) developed advanced CKD after 9.5 years on average (37 with ESKD). At baseline, these patients had a higher SLICC/Damage Index (0.6±1.2 vs. 0.3±0.7, p=0.003), lower eGFR (73±38 vs. 94±33ml/min/1.73m2, p<0.001), higher prevalence of hypertension (85% vs. 73%, p=0.046), proliferative nephritis (combined class III and IV, 66% vs. 47.8%, p=0.017) and more often treated with ACE inhibitors or angiotensin receptor blockers (35% vs. 22%, p=0.02). The other variables did not differ significantly. Remission rates, flares and exposure to immunosuppressives after remission are shown in Table 1.

Table 1.

A. Time to remission, exposure to immunosuppressives and flares in all patients

VARIABLEAdvanced CKD (n=66)No advanced CKD (n=352)pYears from LN to complete remission3.0 ± 3.41.6 ± 2.1<0.001Years on Immunosuppressives from complete remission to outcome/last date (median)2 (0-7)4 (0-8)0.008Number of flares in first five years after LN 012 (18.2%)156 (44.3%)<0.001 114 (21.2%)79 (22.4%) 2 or more40 (60.6%)117 (33.2%)B. Multivariate analysis for the outcome of advanced CKD (stage IV or worse)HR95%CIpSerum creatinine at baseline1.021.01-1.02<0.0001Complete remission between 1-3 years (compared to remission within 1 year)2.481.14-5.370.022Complete remission after 3 years or no remission (compared to remission within 1 year)2.991.41-6.340.004Years on Immunosuppressives from complete remission to outcome/last date0.890.83-0.95<0.0001One flare (compared to no flares)2.681.05-6.860.04Two or more flares (compared to no flares)3.551.51-8.340.004

Patients who achieved remission within one year from diagnosis demonstrated better outcomes compared to all other groups (p<0.0001), Figure 1. Patients with complete remission between one and three years had similar outcomes for the first 10 years from diagnosis and deteriorated during the second decade of follow-up.

Figure 1.

Conclusion

Complete remission within the 1st year from LN diagnosis strongly protects against advanced CKD. Flares significantly affect prognosis. One flare was associated with 2.7-fold increased risk for advanced CKD (3.6-fold for 2 or more flares). Longer time on immunosuppressives after remission is associated with decreased risk for advanced CKD. Our findings emphasize the importance of early remission as well as flare prevention with prolonged immunosuppressive use to maximize renal survival in LN.

References

[1]Tselios K, Gladman DD, Su J, Urowitz MB. Advanced Chronic Kidney Disease in Lupus Nephritis: Is Dialysis Inevitable? J Rheumatol 2020; 47: 1366-73

Acknowledgements

The University of Toronto Lupus Clinic is supported by a grants from Lupus Ontario and Lupus Canada and donations from the Marissa and Lou Rocca, Diana and Mark Bozzo and the Stacey and Mark Krembil Families.

Disclosure of Interests

Konstantinos Tselios: None declared, Dafna D Gladman Consultant of: AstraZeneca, Jiandong Su: None declared, Murray B Urowitz Consultant of: GlaxoSmithKline, AstraZeneca, Merck, Bayer, UCB, Grant/research support from: GlaxoSmithKline

POS1332 TOWARD SAFER GLUCOCORTICOID THERAPY OF POLYMYALGIA RHEUMATICA

Background

SPI-62 is a potent 11β-hydroxysteroid dehydrogenase type 1 (HSD-1) inhibitor entering Phase 2 development as adjunctive therapy to prednisolone in polymyalgia rheumatica, as well as for treatment of Cushing’s syndrome and autonomous cortisol secretion. HSD-1, an intracellular enzyme, activates glucocorticoids in target tissues in which glucocorticoid medicines are associated with morbidity including liver, adipose, muscle, and skin. In Phase 1 clinical trials SPI-62 was generally well tolerated and associated with maximal liver and brain HSD-1 inhibition.

Objectives

To demonstrate mitigation by SPI-62 of corticosterone (CORT) adverse effects in mouse.

Methods

C57BL/6 male mice (age 7 weeks; n=14 per group) were administered CORT (100 g/mL in drinking water) and SPI-62 (by gavage in 0.5% HPMC; 0, 1, or 10 mg/kg/day or 10 mg/kg twice daily) for 35 days. A control group received no CORT or SPI-62. Body weight was assessed daily and food consumption twice weekly. Whole body muscle and fat amounts were measured at Days 0, 14, and 28 using an EchoMRI-130H body composition analyzer. Blood samples for fasting glucose and insulin were obtained at Days 1 (pre-dose), 15, 29, and 35. An open field test was conducted on Day 22. A grip strength test was performed on Day 28. After sacrifice on Day 36, gonadal, subcutaneous, retroperitoneal, and mesenteric fat, quadriceps, and tibialis anterior were dissected and weighed, and skin was formalin fixed and paraffin embedded.

Results

One control mouse died due to accidental gavage injury. Two mice who received CORT + 0.5% HPMC died on Days 11 and 19. CORT resulted in increased food consumption which was normalized by SPI-62 in a dose-dependent manner. CORT-treated mice showed reduced body weight gain for 2 weeks then accelerated body weight gain. SPI-62 prevented body weight gain acceleration in a dose-dependent manner. CORT effects on dermal thickness and structure were less prominent in mice who also received SPI-62. No effect of CORT or SPI-62 was observed in the open field test. SPI-62 prevented CORT adverse effects of insulin resistance, increased adiposity, skeletal myoatrophy, and grip strength reduction (Table 1).

Table 1.

Observed percentage difference of treatment group mean, compared to control group mean, in CORT-treated mice

SPI-62 treatmentnone1 mg/kg1x/day10 mg/kg1x/day10 mg/kg2x/dayHOMA-IR Day 15+422+428+104+8HOMA-IR Day 29+788+472+204+14HOMA-IR Day 35+3620+1270+324+92Body fat content Day 14*+110+72-13-7Body fat content Day 28*+166+102+63-12Gonadal fat weight*+151+74+39-1Subcutaneous fat weight*+471+121+83+7Retroperitoneal fat weight*+227+89+36+25Mesenteric fat weight*+240+133+124+71Body muscle content Day 14*-10-70+1Body muscle content Day 28*-15-8-6+3Quadriceps weight*-54-43-24-16Tibialis anterior weight*-35-29-5+5Grip strength-12+16+15+26

*Normalized by body weight.

Conclusion

SPI-62 prevented several CORT adverse effects in mouse, demonstrating that blockade of local intracellular glucocorticoid activation by a HSD-1 inhibitor in target tissues can mitigate glucocorticoid toxicity. These results suggest that SPI-62 has potential to similarly mitigate adverse effects of glucocorticoid medications in human. A placebo-controlled Phase 2 clinical trial has been initiated to compare prednisolone effects with and without SPI-62. Up to 48 patients diagnosed with polymyalgia rheumatica, on stable prednisolone 10 mg daily for at least 2 weeks, and with stable disease inactivity based on acute phase biomarkers will continue prednisolone 10 mg daily for 4 weeks, during which they will receive SPI-62 or placebo for 2 weeks each. Acute phase and other immune function biomarkers, symptom measures, and biomarkers of prednisolone adverse effects will be assessed at baseline and after each 2-week period. After analysis of data from a first cohort of 12 patients the prednisolone dose might be adjusted, in blinded fashion, during the SPI-62 period to maintain equipotency on acute phase biomarker suppression.

Disclosure of Interests

Xingyu Pan: None declared, Qiongqiong Hou: None declared, Jiahui Xu: None declared, Yake Ma: None declared, Jiawen Li: None declared, Min Li: None declared, Jing Su: None declared, Xuerou Shi: None declared, William Bracken Consultant of: Sparrow Pharmaceuticals, David Katz Shareholder of: Sparrow Pharmaceuticals, Employee of: Sparrow Pharmaceuticals

POS0015 BULLOUS SYSTEMIC LUPUS ERYTHEMATOSUS SUCCESSFULLY TREATED WITH MYCOPHENOLATE MOFETIL COMBINED WITH GLUCOCORTICOID: A CASE REPORT

Background:

Bullous systemic lupus erythematosus (BSLE) is a rare subtype of systemic lupus erythematosus, accounting for less than 1% of systemic lupus erythematosus (SLE) [1]. It is common in adults aged 20 to 40, with female predominace [2]. Its skin manifestations are mainly tensive blisters, especially involving oral and genital mucosa, Nissl’s sign is mostly negative, blisters break and heal to form pigmentation of varying degrees, leaving no scar. At present, the main treatment is systemic application of corticosteroids combined with immunosuppressants. Here, we report a BSLE who successfully treated with mycophenolate mofetil (MMF) combined with glucocorticoid.

Objectives

To be vigilant in the early identification of BSLE, and through the treatment experience of this case, it can provide a basis for the use of Mycophanol ester as the preferred drug for the treatment of BSLE in the future.

Methods

The clinical manifestation, laboratory test, treatment, and outcome were described.

Results

A 50-year-old female patient with systemic lupus erythematosus presented with wandering joint pain for 1 year and sporadic patchy erythema on eyelid, hands, and neck for 7 months. There are blisters on part of her erythema and normal skin, about 1mm-15mm in diameter, the blister fluid is cool, fusion is broken, and Nissl’s sign is negative. She suffered from anemia, albuminuria, polyserous effusion and other system damage. Skin histopathology showed mild hyperkeratosis of epidermis, formation of subepidermal blisters and accumulation of a large number of neutrophils; direct immunofluorescence showed that the positive expressions of IgA, IgG and C3 were found in the basement membrane of the skin, leading to a diagnosis of BSLE. In the initial stage, patients were treated with high-dose glucocorticoid (160 mg, qd) combined with immunosuppressants (thalidomide and hydroxychloroquine), but the number of blisters increased. After treatment with MMF (1 g, bid), the skin lesions disappeared, joint pain relieved, anemia was corrected, and polyserous effusion was absorbed. She was followed up for half a year and there was no recurrence.

Conclusion

Patients with BSLE are often accompanied by multiple system damage [2], so it is critical to correctly identify BSLE and provide appropriate treatment as soon as possible. For patients who do not respond to single glucocorticoid therapy, combined with MMF can be used as the preferred drug for the treatment of BSLE in the future.

References:

[1] L. Duan et al., Treatment of Bullous Systemic Lupus Erythematosus. Journal of immunology research 2015, 167064 (2015).

[2] K. Chanprapaph, S. Sawatwarakul, V. Vachiramon, A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients. Lupus 26, 1278-1284 (2017).

Figure 1.

BSLE. Blisters can be seen on the face, neck, armpits and arms.

BSLE = bullous systemic lupus erythematous.

Disclosure of Interests

None declared

OP0140 IMPACT OF TIME TO REMISSION, FLARES AND TIME ON IMMUNOSUPPRESSIVES ON THE ESTIMATED GLOMERULAR FILTRATION RATE IN LUPUS NEPHRITIS

Background

Time to complete remission, subsequent flares and time on immunosuppressives after complete remission are major determinants of the progression to advanced chronic kidney disease in lupus nephritis (LN). However, the impact of these factors on the rate of glomerular filtration rate (GFR) deterioration is not known.

Objectives

To determine the impact of time to remission, flares and time on immunosuppressives after remission on the estimated GFR in LN.

Methods

Patients with LN based on biopsy or abnormal proteinuria (>0.5g/day) with or without hematuria or pyuria or casts for two consecutive visits were retrieved from the Toronto Lupus Clinic long-term longitudinal database. Individuals with advanced chronic kidney disease at baseline (eGFR≦29ml/min/1.73m2) were excluded. All patients were followed for at least 5 years. The primary outcome was any decrease of the estimated GFR on an annual basis (slope). Remission was defined as proteinuria<0.5g/24h, inactive urinary sediment and serum creatinine ≤120% of the baseline value. Flare was defined as any abnormal proteinuria (>0.5g/day) or increase in serum creatinine (SCR) from normal to abnormal or >120% of the baseline value after remission. Slopes of eGFR changes (standard error) were calculated using Ordinary Least Square method in each complete remission/flare group. Linear Mixed model was performed to account for factors associated with deterioration of eGFR.

Results

Out of 418 eligible patients, 209 (50%) achieved remission within the first year from LN diagnosis, 102 (24.4%) within the 2nd and 3rd years, 70 (16.7%) after 3 years and 37 (8.9%) never achieved remission. Regarding flares, 82 patients (19.6%) never flared, 75 (18%) had one flare and 261 (62.4%) had two or more flares. The trajectory and annual slope of eGFR according to time to remission and number of flares is shown in the Figure 1.

Figure 1.

Regression analysis (linear mixed model) for the outcome of eGFR was performed to adjust for other variables that impact eGFR (Table 1).

PredictorsEstimateStandard Errorp valueEach one later decade of LN onset4.450.93<0.0001Years on immunosuppressives since remission0.710.19<0.0001Age at LN onset-0.760.11<0.0001Hypertension at LN-7.732.750.005CR < 1 year after LN0 (Ref.)CR between 1-3 years comparing to < 1 year after LN-1.602.900.581No CR or CR later than 3 years comparing to < 1 year after LN-12.312.90<0.0001No Flare0 (Ref.)One flare any time after LN vs. no flare-3.483.790.358Two or more flares any time after LN vs. no flare-14.793.01<0.0001

Conclusion

Complete remission after 3 years or no remission is associated with a significant decrease in eGFR, while remission during the 2nd and 3rd year from LN diagnosis is not associated with significant decrease of renal function over time. Patients with one flare did not have significant impact on their renal function. Patients with 2 or more flares had a significant decrease of eGFR over 20 years, even after adjustment for other covariates. Time on immunosuppressives after complete remission is protective against eGFR decline. Our findings emphasize the importance of rapid remission and flare prevention by prolonged maintenance treatment with immunosuppressives to optimize renal outcomes.

Acknowledgements

The University of Toronto Lupus Clinics is supported by grants from Lupus Ontario and Lupus Canada and donations from the Marissa and Lou Rocca, the Diana and Mark Bozzo and the Stacey and Mark Krembil Families.

Disclosure of Interests

Konstantinos Tselios: None declared, Dafna D Gladman Consultant of: AstraZeneca, Jiandong Su: None declared, Murray B Urowitz Consultant of: GlaxoSmithKline, AstraZeneca, Merck, Bayer, UCB, Grant/research support from: GlaxoSmithKline

[Tracing investigation and analysis of a Clostridium botulinum food poisoning incident in Bayingolin Mongolian Autonomous Prefecture, Xinjiang]

To analyze a suspected case of Clostridium botulinum food poisoning in Bayingolin Mongolian Autonomous Prefecture, Xinjiang and to help validating the diagnosis and providing technical support for clinical treatment. The basic information and clinical manifestations of food poisoning cases were investigated by using the epidemiological method of food safety accidents. The botulinum toxin genes in the samples were detected by real-time PCR and inoculation of KM mouse. The enriched bacteria were further purified and validated. PFGE and cluster analysis were performed on five isolates. Clostridium botulinum type A was detected in two homemade fermented bean samples and stool lavage fluid samples of three patients from enriched samples by toxin test and real-time PCR, and were further validated after isolation of Clostridium botulinum. PFGE showed 100% homology among five isolates. Five isolates of bacteria isolated from the stool lavage fluid of three patients and two homemade fermented bean curd were identified as the same source through PFGE. The cause of this food poisoning cases is food pollution of Clostridium botulinum type A.

[Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit]

Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ²=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ²=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.

Direct measurement of the 19F(p, αγ)16O reaction in JUNA

The 19F(p, αγ)16O reaction is of crucial importance for Galactic 19F abundances and CNO cycle loss in first generation Population III stars. Due to its extremely small cross sections, the 19F(p, αγ)16O reaction has not been measured in the low energy part of the Gamow window(70-200 keV). As a day-one campaign, the experiment was performed under the extremely low cosmicray-induced background environment of the China JinPing Underground Laboratory(CJPL), one of the deepest underground laboratories in the world. The γ-ray yields were measured over Ec.m. =72.4–344 keV, covering the full Gamow window for the first time. The direct experimental data will help people to expound the fluorine over-abundances, energy generation, as well as heavy-element nuclosynthesis scenario in asymptotic giant branch (AGB) stars, with the astrophysical model on the firm ground.

First measurement of 25Al+p resonant scattering relevant to the astrophysical reaction 22Mg(α,p)25Al

Type I X-ray bursts (XRBs) are the most frequently observed thermonuclear explosions in nature. The 22Mg(α,p)25Al reaction plays a critical role in XRB models. However, experimental information is insufficient to deduce a precise 22Mg(α,p)25Al reaction rate for the respective XRB temperature range. A new measurement of 25Al+p resonant scattring was performed up to the astrophysically interested energy region of 22Mg(α,p)25Al. Several resonances were observed in the excitation functions, and their level properties have been determined based on an R-matrix analysis. In particular, proton widths and spin-parities of four natural-parity resonances above the α threshold of 26Si, which can contribute the reaction rate of 22Mg(α,p)25Al, were first experimentally determined.

Murphy A, Su J, Fang X, Kwag M, Duy N, Uyen N, Kim D, Liang J, Psaltis A, Sferrazza M, Johnston Z, Li Y. Experimental studies on astrophysical reactions at the low-energy RI beam separator CRIB

Experimental studies on astrophysical reactions involving radioactive isotopes (RI) often accompany technical challenges. Studies on such nuclear reactions have been conducted at the low-energy RI beam separator CRIB, operated by Center for Nuclear Study, the University of Tokyo. We discuss two cases of astrophysical reaction studies at CRIB; one is for the 7Be+n reactions which may affect the primordial 7Li abundance in the Big-Bang nucleosynthesis, and the other is for the 22Mg(α, p) reaction relevantin X-raybursts.

Association of prenatal renal ultrasound abnormalities with pathogenic copy number variants in a large Chinese cohort

OBJECTIVES

To assess the clinical utility of prenatal chromosomal microarray analysis (CMA) in fetuses with abnormal renal sonographic findings, and to evaluate the association of pathogenic or likely pathogenic copy number variants (P/LP CNVs) with different types of renal abnormality.

METHODS

This was a retrospective study of fetuses at 14-36 weeks screened routinely for renal and other structural abnormalities at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. We retrieved and analyzed data from fetuses with abnormal renal sonographic findings, examined between January 2013 and November 2019, which underwent CMA analysis using tissue obtained from chorionic villus sampling (CVS), amniocentesis or cordocentesis. We evaluated the CMA findings according to type of renal ultrasound anomaly and according to whether renal anomalies were isolated or non-isolated.

RESULTS

Ten types of renal anomaly were reported on prenatal ultrasound screening, at a mean ± SD gestational age of 24.9 ± 4.8 weeks. The anomalies were diagnosed relatively late in this series, as 64% of cases with an isolated renal anomaly underwent cordocentesis rather than CVS. Fetal pyelectasis was the most common renal ultrasound finding, affecting around one-third (34.32%, 301/877) of fetuses with a renal anomaly, but only 3.65% (n = 11) of these harbored a P/LP CNV (comprising: isolated cases, 2.37% (4/169); non-isolated cases, 5.30% (7/132)). Hyperechogenic kidney was found in 5.47% (n = 48) of fetuses with a renal anomaly, of which 39.58% (n = 19) had a P/LP CNV finding (comprising: isolated cases, 44.44% (16/36); non-isolated cases, 25.00% (3/12)), the highest diagnostic yield among the different types of renal anomaly. Renal agenesis, which accounted for 9.92% (n = 87) of all abnormal renal cases, had a CMA diagnostic yield of 12.64% (n = 11) (comprising: isolated cases, 11.54% (9/78); non-isolated cases, 22.22% (2/9); unilateral cases, 11.39% (9/79); bilateral cases, 25.00% (2/8)), while multicystic dysplastic kidney (n = 110), renal cyst (n = 34), renal dysplasia (n = 27), crossed fused renal ectopia (n = 31), hydronephrosis (n = 98), renal duplication (n = 42) and ectopic kidney (n = 99) had overall diagnostic rates of 11.82%, 11.76%, 7.41%, 6.45%, 6.12%, 4.76% and 3.03%, respectively. Compared with the combined group of CMA-negative fetuses with any other type of renal anomaly, the rate of infant being alive and well at birth was significantly higher in CMA-negative fetuses with isolated fetal pyelectasis or ectopic kidney, whereas the rate was significantly lower in fetuses with isolated renal agenesis, multicystic dysplastic kidney or severe hydronephrosis. The most common pathogenic CNV was 17q12 deletion, which accounted for 30.14% (22/73) of all positive CMA findings, with a rate of 2.51% (22/877) among fetuses with an abnormal renal finding. Fetuses with 17q12 deletion exhibited a wide range of renal phenotypes. Other P/LP CNVs in the recurrent region that were associated with prenatal renal ultrasound abnormalities included 22q11.2, Xp21.1, Xp22.3, 2q13, 16p11.2 and 1q21, which, collectively, accounted for 2.17% (19/877) of the fetuses with prenatal renal anomalies.

CONCLUSIONS

In this retrospective review of CMA findings in a large cohort of fetuses with different types of renal ultrasound abnormality, the P/LP CNV detection rate varied significantly (3.03-39.58%) among the different types of kidney anomaly. Our data may help in the decision regarding whether to perform prenatal genetic testing in fetuses with renal ultrasound findings. Specifically, prenatal CMA testing should be performed in cases of hyperechogenic kidney, regardless of whether or not the anomaly is isolated, while it should be performed postnatally rather than prenatally in cases of fetal pyelectasis. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

[Epidemiological characteristics and influencing factors for high risk cardiovascular disease population in Jiangsu province]

Objective: To investigate the detection types and aggregation of high-risk population of cardiovascular disease (CVD) in Jiangsu province and the related influencing factors to provide reference for the prevention and control of cardiovascular disease. Methods: A total of 120 211 participants were included in the investigation. Information was collected by questionnaire based survey, physical examination and biochemical tests. χ² test and multivariate logistic regression were used for statistical analysis. Results: The detection rate of CVD high risk was 25.03%. The detection rates were 19.01%, 4.85%, 3.18% and 5.31% for hypertension, dyslipidemia, cardiovascular history and WHO assessed risk ≥20% types, respectively. Male, rural, old age, low education level, low family income, drinking, waist circumference exceeding standard, overweight and obesity were risk factors of CVD (all P<0.01). The composition ratios of aggregation of 1, 2 and ≥3 high risk types of CVD were 74.01%, 22.91% and 3.08%, respectively. With the increase of aggregation types, the correlation strength increased with age, rural residents, education level and annual family income. Conclusion: Targeted measures should be carried out according to different influencing factors for the prevention and control of CVD in Jiangsu province in order to achieve the maximum prevention and control effect with the minimum cost.

[Mediating effect of physical activity on association between sedentary leisure-time and obesity indexes among hypertensive individuals]

Objective: To explore the mediating effect of physical activity on association between sedentary leisure-time and obesity indexes among hypertensive individuals. Methods: After excluding of those with a prior history of heart disease, stroke and cancer, a total of 20 178 hypertensive participants in the China Kadooire Biobank (CKB) study from Wuzhong district of Suzhou city were included. Mediating effect analysis was used to analyze the mediating effect of physical activity (PA) on correlation between sedentary leisure-time and body fat percentage (BFP), waist circumference (WC) and body mass index (BMI). Results: After adjusted for age, gender, smoking status, alcohol consumption, education levels, intake frequencies of meat and intake frequencies of fresh fruit, sedentary leisure-time (SLT) was negatively correlated with PA (β=-0.246, P<0.001), but positively associated with BFP (β=0.061, P<0.001), WC (β=0.087, P<0.001) and BMI (β=0.071, P<0.001). After including the mediator variable PA, the direct effect of SLT on obesity index was still significant. PA was negatively correlated with BFP, WC and BMI (β=-0.052, -0.083 and -0.028, respectively, P<0.001). Analysis of mediating effect indicated that the association of SLT with BFP, WC and BMI were partly mediated by PA, the proportion of mediating effect was 20.820%, 23.421% and 9.915%. Stratified by gender, PA had mediating effect on SLT and all obesity indexes in women, while only on SLT and BFP and WC in men. Conclusions: There is a significant mediating effect of PA on correlation between SLT and obesity indexes among hypertensive individuals. Hypertensive patients should increase the level of physical activity and reduce sedentary behavior to achieve a profounder healthy effect.

[Development of case report form based on clinical data interchange standards consortium on special diseases to promote the ecology construction of real-world data in China]

Real world data (RWD) refers to the data generated in routine clinical practices, daily life, and real work environment and has been widely used in clinical or public health research. Still, issues related to the quality of RWD, such as incompleteness, inconsistency, and inaccuracy, would affect the validity of real-world research. To overcome the challenges due to the lack of standardization of real world source data, case report form based on clinical data interchange standards consortium (CDISC-CRF) on certain diseases was developed to promote the ecology construction of RWD based on the data standards set by the CDISC which has been widely used. Firstly, we described how to apply data standards to make up the gap between RWD and real world evidence. Then, the process was designed to build RWD ecology based on CDISC-CRF, in which the development technology of CDISC-CRF form is mainly introduced. Finally, the application prospect and significance of building real-world data based on disease-specific CDISC-CRF are described. It is believed that the present paper can provide a new idea for promoting the ecology construction of RWD in China.