[A new insights of mesorectum]

Total mesorectal excision (TME) represents the gold standard for radical resection in rectal cancer. The development in radiology and laparoscopic surgical equipment and the advancement in technology have led to a deepened understanding of the mesorectum and its surrounding structures. Both the accuracy of preoperative staging and the preciseness of the planes of TME surgical dissection have been enhanced. The postoperative local recurrence rate is reduced and the long-term survival of rectal cancer patients is improved. The preservation of the pelvic autonomic nervous system maintains the patient's urinary and sexual functions to the greatest extent possible, which in turn improves the patient's postoperative quality of life. A thorough understanding of the anatomy of the mesorectum and its surrounding structures is a prerequisite for successful TME. Herein, we review the basic concepts and the anatomy of the mesorectum in the current literature. Some important clinical issues are also discussed systematically in terms of imaging, surgery, and pathology.

SERS Detection of Benzoic Acid in Milk by Using Ag-COF SERS Substrate

Benzoic acid, which has a pivotal role in food additive, is prohibited to add as a preservative in dairy products. China, Brazil, and other countries have proposed standard methods to detect the addition of benzoic acid in food. Surface-enhanced Raman scattering (SERS) is an upcoming spectral detection technique, which has been widely used in the field of material analysis with the advantages of non-invasive, fast detection speed and complex environment with little interference. To detect the illegal use of benzoic acid in dairy industry, we developed Ag-COF (covalent-organic framework) material as SERS substrate to detect benzoic acid in liquid milk. The great enhancement ability of Ag-COF substrate is controlled by the addition of acetic acid and complex interplay between COF material and benzoic acid. This detection method has high sensitivity and reliability that allows us to achieve limit of detection (LOD) of 0.13 μg/mL in milk and 0.00372 μg/mL in water by applying this method. In experiment on recovery rate of real samples, the detection time is less than 15 minutes and the relative standard deviation (RSD) ranged from 2.82% to 5.69%. Therefore, this method has practical significance of the detection of benzoic acid in dairy products.

[Resection margin of colorectal cancer surgery]

The judgment of surgical resection margins is an important factor affecting local recurrence and distant metastasis of colorectal cancer, which is crucial to the prognosis of patients. How to select a standard and ideal surgical resection margin is a challenge for colorectal cancer surgeons. Surgical resection margins for colorectal cancer include longitudinal resection margin (LRM) and circumferential resection margin (CRM), and the distance of safe resection margins varies according to different guidelines. Surgical resection margins are mainly evaluated by preoperative imaging, operative experience, operative type, hyperspectral imaging (HPI) and fluorescence angiography (FA), and postoperative pathology. It is the constant pursuit of colorectal cancer surgeons to pay attention to the safe resection margins in colorectal cancer surgery to reduce local recurrence and distant metastasis.

[Exploring the teaching mode about clinical laboratory diagnostic pathway for chronic hepatitis B]

Exploring a new teaching mode of CHB laboratory diagnostics to improve the teaching quality through establishment a teaching model covered the whole process of CHB disease diagnosis and differential diagnosis, treatment, drug selection, the toxicity and side effects prediction, effect monitoring, and prognosis evaluation. According to the CHB clinical diagnosis and treatment guidelines, formulated the laboratory examination and detection strategies related to different stages of CHB, and established CHB clinical laboratory diagnostic pathway. Compared the classroom teaching effect by the questionnaire between the 2016 and 2017 eight-year undergraduates from the First Clinical College of Wuhan University. In this study,the CHB clinical laboratory diagnostic pathway was established and approved by clinicians, which covered the whole process of CHB disease diagnosis and differential diagnosis, treatment, drug selection, the toxicity and side effects prediction, effect monitoring, and prognosis evaluation. The teaching quality evaluation indicators and the scores on the class test had been greatly improved with the clinical diagnostic pathway teaching mode in the classroom teaching of 2017 clinical medicine undergraduates compared with the traditional teaching mode in the 2016 clinical medicine undergraduates. In summary, the medical students not only could realize the organic integration of laboratory diagnostics and clinical medicine, but also improves overall understanding of various laboratory tests in CHB diagnosis and treatment from the teaching model of laboratory diagnostics based on the CHB clinical laboratory diagnostic pathway,and the quality of teaching for CHB has been significantly improved.

Effects of konjac glucomannan/pomegranate peel extract composite coating on the quality and nutritional properties of fresh-cut kiwifruit and green bell pepper

The effects of an edible coating, based on konjac glucomannan (KG) incorporated with pomegranate peel extracts (PE), on the physicochemical and nutritional properties of fresh-cut kiwifruit and green bell pepper during storage were investigated. The optimal extract time (40.6 min), temperature (54.5 °C), and ultrasound power (255.5 W) with response surface method, provided a high total antioxidant activity (TAA) of (92.31 ± 1.43)%. Fresh-cut kiwifruit and green bell pepper were coated by dipping using five treatments (distilled water, ascorbic acid, KG, PE, KG + PE), packed into polymeric film and stored for 8 days at 10 °C. Distilled water treatment was used as control. KG + PE treatment resulted in the highest total soluble solid and titratable acidity in fresh-cut kiwifruit, while the maximum firmness in fresh-cut green bell pepper. The weight loss was both effectively decreased in samples treated with KG or KG + PE. All samples treated with KG + PE had significantly higher contents of chlorophyll, ascorbic acid, total phenolic and TAA than others. Moreover, the KG + PE group had the lowest counts of microorganisms in all samples. KG coating incorporated with PE was proved to be efficient in maintaining the physico-chemical and nutritional properties of fresh-cut kiwifruit and green bell pepper during low temperature storage compared with control.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13197-021-05006-7.

The expression profile of long non-coding RNAs in the lung tissue of mice with cecal ligation and puncture-induced sepsis

When sepsis occurs, the lungs are the first organs that are affected. Injury to the lungs involves damage to and the subsequent repair of cells and tissue. However, the mechanism of both at a molecular level remains unclear. As mice have similar physiological and pathological processes to humans, the current research adopted mice models to explore the long non-coding ribonucleic acid (lncRNA) in the lung tissue of mice with cecal ligation and puncture (CLP)-induced sepsis using gene sequencing analysis. A total of 30 mice were randomly divided into two groups, i.e., the sham group and the CLP group, respectively. Three mice were randomly selected from each group, and their lung tissue was used for gene sequencing analysis. Overall, a total of 1,110 lncRNAs were found to be significantly differentially expressed between the two groups. Among these, 658 were over-expressed, and 452 were under-expressed (fold change ≥ 2.0, P < 0.05). Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to predict the potential biological functions of these differentially expressed lncRNAs, and the top 10 over- and under-expressed lncRNAs were selected as candidates for further validation. Finally, three over-expressed lncRNAs (XLOC_025752, XLOC_086176, and XLOC_148721) and four under-expressed lncRNAs (XLOC_120813, XLOC_029657, XLOC_031620, and XLOC_096198) were validated and found to be the same as those identified by sequencing analysis. To the best of the authors's knowledge, this research is the first to explore the expression profile of lncRNAs in the lung tissue of mice with CLP-induced sepsis. The results showed different lncRNA expression profiles between the two groups, indicating that lncRNAs may contribute to the occurrence of and recovery from sepsis-induced acute lung injury through interacting with target genes.

Urea detection in milk by urease-assisted pH-sensitive carbon dots

Excessive urea in milk will lead to serious health problems. To detect whether the urea concentration in milk exceeds the standard and ensure the quality of milk, it is necessary to develop detection technology for urea in milk. But it is difficult to detect urea in milk conveniently and accurately by traditional methods. To measure the concentration of urea in milk, stable green light carbon dots (CDs) were synthesized by a one-step method as a fluorescent probe. Then, 3, 5-diaminobenzoic acid was used as the precursor for CD synthesis. Experimental results showed that CDs can generate strong fluorescence when excited by light (350-450 nm). The fluorescence peak wavelength is 490 nm, and the optimum excitation wavelength is 390 nm. The fluorescence intensity of CDs has a significant change with variations of pH (pH of 6-9), and the higher the pH, the lower the fluorescence intensity. Additionally, urea can be hydrolyzed by urease to produce ammonia and carbon dioxide. Ammonia is ionized in water to produce OH^-, which increases the pH of the solution. After adding standard urea to milk, urease and CDs are added. The fluorescence intensity of CDs in the mixed solution decreases as the concentration of standard added urea increases. Thus the concentration of urea in milk can be calculated. The experimental results show that the CD method for detecting urea in milk has advantages of high sensitivity and wide measurement range. The linear interval is 25-500 mg/L, R² is 0.998, and the limit of detection is 6.27 mg/L. The concentration of urea in the milk used in the experiment is 265.46 mg/L. CDs are easy to fabricate, and the advantages of the method are simple operation, no pretreatment, safety, and low cost. A new method for the detection of urea in milk was established, to the best of our knowledge, and this method can aid in food quality control.

[Analysis on influencing factors of HIV testing services utilization in students with self-assessed high risk of HIV infection based on Andersen's model]

Objective: To analyze the influencing factors for HIV testing services utilization in students with self-assessed high risk of HIV infection. Methods: The research framework of the influencing factors for HIV testing services utilization in students was developed based on Andersen's health services utilization behavioral model and related literature. A cross-sectional survey was performed in students with self-assessed high risk of HIV infection by an online HIV infection risk assessment tool from March to April 2019. Multiple logistic regressions were applied with hierarchical model. Results: A total of 526 students were included in the study (age: 19.30±1.19 years old), in whom 96.2% agreed that HIV testing should be received after high-risk behavior. 56.7% (298/526) had sexual behavior and the HIV testing rate was 11.0% (58/526). The HIV testing rates in students who had and had no sex behavior were 13.42%(40/298) and 7.89% (18/228), respectively. According to the results from multivariate logistic regression analysis, non-heterosexual (compared with heterosexual, OR=7.88, 95%CI: 3.98-15.61) and higher score of AIDS knowledge awareness (compared with lower score, OR=2.05, 95%CI: 1.07-3.93) in propensity factor module, and having risk sexual behavior (compared with having no risk sexual behavior, OR=2.66, 95%CI: 1.41-5.03) and having diagnosis of STD infection in hospital (compared with having no such diagnosis, OR=6.35, 95%CI: 2.21-18.27) in demand factor module, and receiving health education about AIDS prevention in the past year (compared with receiving no such health education, OR=0.29, 95%CI: 0.11-0.76) and receiving health education about AIDS testing service in the past year (compared with receiving no such health education, OR=3.67, 95%CI: 1.71-7.90) in ability factor module were the influencing factors for utilization of HIV testing services. Conclusions: The acceptance of HIV testing in students needs to be improved urgently. Propensity factors, such as their AIDS knowledge awareness and sexual orientation, and demand factors, such as having risk sexual behavior and STD infection, have obvious impacts on the utilization of HIV testing services. However, health education about AIDS prevention and HIV testing service can play a more important role in facilitating the utilization of HIV testing in students. In the future, we should further strengthen the publicity of voluntary HIV counseling and testing service in students with particular attention to girls and those with risk sexual behaviors.

A Lanthanide Complex Fluorescent Probe for the Detection of Melamine

Melamine has been illegally adulterated in dairy food because of the rich nitrogen content and stable chemical properties in recent years. Therefore, the detection of melamine is of great significance for food safety supervision and human health protection. As melamine is a weak fluorescent substance, it is difficult to detect melamine directly by fluorescence spectroscopy. In this work, we found that melamine can significantly enhance the emission of the tetracycline-europium (EuTC) complex at 616 nm. Therefore, we took EuTC complex as a fluorescent probe to detect melamine. According to the characterizations of absorption spectra, molecular electrostatic potential distribution, and the time-resolved spectra, we speculated that tetracycline and melamine may form a complex through hydrogen bonding interaction in the melamine-EuTC reaction system, causing the melamine closer approach to Eu³⁺ and reducing the non-radiative energy loss of water molecules to Eu³⁺, which significantly enhanced the fluorescence intensity of EuTC. The fluorescence intensity of EuTC complex with melamine concentration in the range of 0.5-40.0 μM shows a good linear relationship, and the correlation coefficient is 0.9951 with the detection limit of 7.85 × 10^-8M. It shows a high sensitivity for the EuTC complex as a fluorescent probe to detect melamine, which provides a supplement and extension for the detection of melamine by fluorescence spectroscopy.

Photoswitchable solvent-free DNA thermotropic liquid crystals toward self-erasable shape information recording biomaterials

Soft thermotropic liquid crystals (TLCs) have advantages on processability and shape memory compared to hard solids and fluids. The development of photoswitchable soft TLCs based on biomolecules would afford reworkable shape information recording biomaterials for the areas requiring biocompatibility and degradability. In recent years, anhydrous DNA TLCs composed of DNA and ammonium surfactants have been receiving continuous attention. However, the photoswitchable phase transition has not been realized for soft DNA TLCs at room temperature, owing to the absence of functional ammonium surfactant. Herein, a new type of azobenzene-containing surfactant would be applied to the fabrication of soft DNA TLCs with photoresponsive physical properties. The double-chain design of the used surfactant and the use of DOAB as a dopant guarantee the soft state of DNA TLCs at r.t., which also facilitates the azobenzene isomerization by reducing the packing density of surfactants. With the assistance of photoisomerization of azobenzene, the reported DNA TLCs achieve reversible liquid crystal-isotropic liquid transition at temperatures below clearing points even at room temperature. The repeatable shape information recording and self-erasing tests indicate these DNA TLCs would be good shape information recording biomaterials in the future. This work also provides a useful strategy for designing photoresponsive soft biomaterials based on rigid biomolecules like DNA.

The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND

Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD).

OBJECTIVES

To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD.

METHODS

In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16.

RESULTS

Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group.

CONCLUSIONS

In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.

[Clinical pathological characteristics of 4 cases of gastric gland-derived tumors]

Objective: To investigate the pathological features of gastric tumor originated from the fundic gland, including oxyntic gland adenoma (OGA) and gastric adenocarcinoma of the fundic gland (GA-FG). Methods: A retrospective analysis of 2 cases of OGA and 2 cases of GA-FG admitted to our hospital from February 2019 to September 2019 was performed. The histological features were analyzed by immunohistochemical staining combined with endoscopic observation. Results: The four cases arose from the deep layer of the lamina propria mucosae and well differentiated. Two cases of OGA confined to the mucosa, including 1 case of irregular tubules showing low-degree dysplasia and another case of irregular branching and anastomosing tubules showing high-degree dysplasia. Two cases of GA-FG combined with submucosal invasion, showed irregular branching and anastomosing tubules and formed a so-called "endless glands" pattern. Atypia, helicobacter pylori (HP) infection, chronic gastritis, intestinal metaplasia, or gastric atrophy were not observed in the superficial epithelium covering the tumor extent. Two cases of OGA and 2 cases of GA-FG showed the same result of immunohistochemical staining: pepsinogen-1 was diffusely positive in the tumor tissues and indicated chief cell differentiation, while positive ATPase and PDGFRA-α indicated parietal cells differentiation. The expression of Syn were positive in all cases, while CD10, MUC2 and CD-X2 were negative. The upregulation of p53 protein or nuclear positivity of β-catenin was not observed. The Ki-67 labeling index in the hot area was approximately 1-5%. Conclusions: GA-FG is a well-differentiated, low-grade malignant novel subtype of gastric cancer. The immunohistochemical markers and narrowband imaging combined with magnifying endoscopy (NBI-ME) enhance the diagnostic sensitivity. Whether Syn positive expression can be one of the diagnostic item needs to be further investigate. The process of tumorigenesis of GA-FG might be the transition from low-grade dysplasia to high-grade dysplasia of OGA and further to submucosal infiltration. However, the mechanism of GAFG was still unclear. Disregulation of the Shh and Wnt/β-catenin signaling pathway might be associated with tumorigenesis of GA-FG. Endoscopic submucosal dissection (ESD) is often the preferred and curative treatment.

Flavor classification and year prediction of Chinese Baijiu by time-resolved fluorescence

Baijiu is a traditional and popular Chinese liquor with enormous sale potential, which is affected by factors such as flavor and storage time. Chinese Baijiu is a complex and transparent mixture that makes analyzing difficult. The utility of time-resolved fluorescence helped to develop a new method to analyze Baijiu. Forty-two Baijiu samples among six brands with three flavors were prepared, and their fluorescence spectra were analyzed with an excitation light of 374.2 nm. Hexanoic acid and ethyl butyrate were found to have an impact on Baijiu fluorescence. The properties of lifetimes in Baijiu were investigated, and its mechanism was studied by calculations through density function theory. Using parameters of fluorescence lifetimes, Baijiu samples were classified according to their flavors. Additionally, the correlations between fluorescence lifetimes and storage time of Baijiu in Luzhou flavor were obtained, leading to a reliable and efficient method to establish the year forecast model of Chinese Baijiu with a mean error of 2.79 months. It also provides an important reference of the utility of time-resolved fluorescence for quantitative research of multi-component systems.

[A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary]

A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.

POS0415 BLOOD-DERIVED DNA METHYLATION EPI-SIGNATURES ASSOCIATED WITH ANKYLOSING SPONDYLITIS

Background:

Most (~90%) of the ankylosing spondylitis (AS) susceptibility loci are undefined and located in non-coding regions. Epigenetic changes may alter the expression of genes involved in AS and explain part of the missing heritability. 1

Objectives:

To identify novel DNA methylation sites significant for AS and comprehensively understand the underlying pathological mechanism.

Methods:

Genome-wide DNA methylation of blood samples from 30 AS patients and 15 health controls was measured on the Infinium® MethylationEPIC BeadChip microarray. Methylome data were analyzed with ChAMP package in R.

Results:

The epigenome-wide association analysis identified 4,794 differentially methylated positions (DMPs) (FDR <0.05 and delta β >0.05), including 3,294 (68.7%) hypermethylated and 1,500 (31.3%) hypomethylated positions in AS patients (Figure 1A). The identified DMPs allowed clear distinction of most AS cases from controls in the PCA (Figure 1B) and unsupervised hierarchical clustering (Figure 1C). KEGG pathway analysis of AS associated DMPs enriched in T cell receptor signaling pathway, Th1 and Th2 cell differentiation. Besides, a total of 1,048 differentially variable positions (DVPs) were identified, the majority of which (974, 92.9%) were hypervariable in AS, while only 74 DVPs were hypovariable. The increased DNA methylation variability in disease were in line with the previous observation in other diseases, indicating the intrinsic heterogeneity in AS patients, which might be influenced by diverse factors, such as disease activity and treatment.

Figure 1.

Conclusion:

Peripheral blood mononuclear cells from AS patients display aberrant DNA methylome and increased DNA methylation variability. The results enhanced our understanding of the important role of DNA methylation in pathology of AS and offered the possibility of identifying new targets for intervention.

References:

[1]Whyte JM, Ellis JJ, Brown MA, et al. Best practices in DNA methylation: lessons from inflammatory bowel disease, psoriasis and ankylosing spondylitis. Arthritis Res Ther 2019; 21:133.

Acknowledgements:

We appreciate all the staff members of the department of rheumatology of the Third Affiliated Hospital of Sun Yat-sen University for assistance and support in the patient’s recruitment and sample collection.

Disclosure of Interests:

None declared

OP0047 IDENTIFICATION OF CLINICAL PHENOTYPES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS ACCORDING TO PERIPHERAL MUSCULOSKELETAL MANIFESTATIONS: A CLUSTER ANALYSIS IN THE INTERNATIONAL ASAS-PERSPA STUDY

Background:

Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.

Objectives:

To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.

Methods:

Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.

Results:

4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).

Figure 1.

Distribution of the peripheral involvement across clusters

Three clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.

Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.

Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.

Conclusion:

These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.

Acknowledgements:

This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.

Disclosure of Interests:

None declared

A Sensitive Surface-Enhanced Raman Spectroscopy Method for Detecting Tetracycline in Milk

Tetracycline, an animal antibiotic, may remain in milk to cause harm to human health. For economic reasons, the abuse of antibiotics is becoming more and more common. Therefore, the abuse of tetracycline has alarmed the dairy industry and many countries such as New Zealand, China, and the USA have proposed strict standards. Surface-enhanced Raman scattering (SERS) is an emerging detection method which has been applied in food detection with the advantages of no complex pretreatment, fast detection, and weak water environment interference. Considering the abuse of antibiotics in dairy industry, we used polydimethylsiloxane (PDMS) plasma cavity as SERS substrate to detect tetracycline in milk. We found that the enhancement ability of PDMS substrate is affected by addition of 4-amino-1-butanol and complex interplay in the milk--tetracycline system. The modified PDMS plasma cavity has high SERS sensitivity that allows us to achieve low detection limit of 0.28 μg/L. The correlation coefficient was 0.987. The detection of tetracycline in milk using PDMS substrate is quick (within 10 min) and it provides a possible method for in-site detection of tetracycline.

Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies

BACKGROUND

Spinal anesthesia is the standard for elective cesarean section but spinal anesthesia-induced hypotension remains an important problem. Accurate prediction of hypotension could enhance clinical decision-making, alter management, and facilitate early intervention. We performed a systematic review of predictors of spinal anesthesia-induced hypotension and their predictive value during cesarean section.

METHODS

PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases were searched for prospective observational studies assessing the diagnostic accuracy of predictors of spinal anesthesia-induced hypotension in elective cesarean section. The quality of studies was assessed and predictors were grouped in domains based on the type of predictor.

RESULTS

Thirty-eight studies (n=3086 patients) were included. In most studies, patients received 500-1000 mL crystalloid preload or 500-2000 mL crystalloid coload. Vasopressors for post-spinal hypotension were boluses of ephedrine 5-15 mg and/or phenylephrine 25-100 µg in most studies. The hypotension rate varied from 29% to 80% based on the definition. For analysis, >30 predictors were classified into seven domains: demographic characteristics, baseline hemodynamic variables, baseline sympathovagal balance, postural stress testing, peripheral perfusion indices, blood volume and fluid responsiveness indices, and genetic polymorphism.

CONCLUSIONS

Environmental and individual factors increased outcome variability, which restricted the value of the autonomic nervous system and peripheral perfusion indices for prediction of spinal anesthesia-induced hypotension. Supine stress tests may reflect parturients' cardiovascular tolerance during hemodynamic fluctuations and may optimize the predictive value of static state predictors. Future research for predicting spinal anesthesia-induced hypotension should focus on composite and dynamic parameters during the supine stress tests.