[Application of medical care cascade in hepatitis C prevention and treatment]

Medical care cascade, a population based method for tracking disease progression from diagnosis to cure, is a framework for monitoring gaps between current health service strategy and achievement of health goals. This paper summarizes the application of medical care cascade in hepatitis C prevention and treatment to facilitate the improvement in this field.

[Expert consensus on the strategy and measures to interrupt the transmission of schistosomiasis in China]

Since 2015 when the transmission of schistosomiasis was controlled in China, the country has been moving towards elimination of schistosomiasis, with the surveillance-response as the main interventions for schistosomiasis control. During the period of the 13th Five-Year Plan, the transmission of schistosomiasis had been interrupted in four provinces of Sichuan, Jiangsu, Yunnan and Hubei and the prevalence of schistosomiasis has been at the historically lowest level in China. As a consequence, the goal set in The 13th Five-Year National Schistosomiasis Control Program in China is almost achieved. However, there are multiple challenges during the stage moving towards elimination of schistosomiasis in China, including the widespread distribution of intermediate host snails and complicated snail habitats, many types of sources of Schistosoma japonicum infections and difficulty in management of bovines and sheep, unmet requirements for the current schistosomiasis control program with the currently available tools, and vulnerable control achievements. During the 14th Five-Year period, it is crucial to consolidate the schistosomiasis control achievements and gradually solve the above difficulties, and critical to provide the basis for achieving the ultimate goal of elimination of schistosomiasis in China. Based on the past experiences from the national schistosomiasis control program and the challenges for schistosomiasis elimination in China, an expert consensus has been reached pertaining to the objectives, control strategy and measures for The 14th Five-Year National Schistosomiasis Control Program in China, so as to provide insights in to the development of The 14th Five-Year National Schistosomiasis Control Program in China.

[Key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period]

Schistosomiasis was once endemic in 12 provinces (municipalities, autonomous regions) along and south of the Yangtze River basin, which seriously damages human health and hinders socioeconomic developments in China. Following the concerted efforts for 70 years, remarkable achievements have been gained in the national schistosomiasis control program of China. However, there are still multiple challenges for elimination of schistosomiasis in the country. This paper describes the current status of schistosomiasis and the challenges during the progress towards the elimination of schistosomiasis, and proposes the goals, key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period.

Wolbachia affects reproduction in the spider mite Tetranychus truncatus (Acari: Tetranychidae) by regulating chorion protein S38-like and Rop

Wolbachia-induced reproductive regulation in hosts has been used to control pest populations, but little is known about the molecular mechanism underlying Wolbachia regulation of host genes. Here, reproductive regulation by Wolbachia in the spider mite Tetranychus truncatus was studied at the molecular level. Infection with Wolbachia resulted in decreasing oviposition and cytoplasmic incompatibility in T. truncatus. Further RNA-seq revealed genes regulated by Wolbachia in T. truncatus. Real-time quantitative polymerase chain reaction (qPCR) showed that genes, including chorion protein S38-like and Rop were down-regulated by Wolbachia. RNA interference (RNAi) of chorion protein S38-like and Rop in Wolbachia-uninfected T. truncatus decreased oviposition, which was consistent with Wolbachia-induced oviposition decrease. Interestingly, suppressing Rop in Wolbachia-infected T. truncatus led to increased Wolbachia titres in eggs; however, this did not occur after RNAi of chorion protein S38-like. This is the first study to show that chorion protein S38-like and Rop facilitate Wolbachia-mediated changes in T. truncatus fertility. In addition, RNAi of Rop turned the body colour of Wolbachia-uninfected T. truncatus black, which indicates that the role of Rop is not limited to the reproductive regulation of T. truncatus.

A polymeric approach toward resistance-resistant antimicrobial agent with dual-selective mechanisms of action

Antibiotic resistance is now a major threat to human health, and one approach to combating this threat is to develop resistance-resistant antibiotics. Synthetic antimicrobial polymers are generally resistance resistant, having good activity with low resistance rates but usually with low therapeutic indices. Here, we report our solution to this problem by introducing dual-selective mechanisms of action to a short amidine-rich polymer, which can simultaneously disrupt bacterial membranes and bind to bacterial DNA. The oligoamidine shows unobservable resistance generation but high therapeutic indices against many bacterial types, such as ESKAPE strains and clinical isolates resistant to multiple drugs, including colistin. The oligomer exhibited excellent effectiveness in various model systems, killing extracellular or intracellular bacteria in the presence of mammalian cells, removing all bacteria from Caenorhabditis elegans, and rescuing mice with severe infections. This "dual mechanisms of action" approach may be a general strategy for future development of antimicrobial polymers.

Downregulation of long non-coding RNA XIST inhibits cell proliferation, migration, invasion and EMT by regulating miR-212-3p/CBLL1 axis in non-small cell lung cancer cells

OBJECTIVE

Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors in the world and its 5-year survival rate is very low. Long non-coding RNA X-inactive specific transcript (lncRNA XIST) has been demonstrated to play vital roles in NSCLC, but the exact molecular mechanisms underlying NSCLC still need to be further explored.

PATIENTS AND METHODS

Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) was performed to detect the expression of XIST, miR-212-3p and Casitas B-lineage proto-oncogene like 1 (CBLL1). Dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay were conducted to analyze the relationship among XIST, miR-212-3p and CBLL1. Cell Counting Kit-8 (CCK-8) assay and transwell invasion assay were carried out to evaluate cell proliferation, migration and invasion, respectively. Western blot analysis was conducted to examine the protein expression of CBLL1, E-cadherin, N-cadherin and Vimentin. Murine xenograft assay was conducted to explore the role of XIST in vivo.

RESULTS

Expression levels of XIST and CBLL1 were markedly upregulated, while the miR-212-3p level was markedly downregulated in NSCLC tissues and cells. MiR-212-3p was identified as a direct target of XIST, and miR-212-3p was predicted to target CBLL1. XIST knockdown repressed NSCLC cell proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) in vitro, and suppressed tumor growth in vivo, while miR-212-3p inhibition restored the effects. Furthermore, CBLL1 overexpression could abolish the effects of miR-212-3p overexpression on NSCLC cell proliferation, migration, invasion and EMT in vitro.

CONCLUSIONS

XIST was significantly decreased in NSCLC tissues and cells, and XIST knockdown suppressed the proliferation, migration, invasion and EMT of NSCLC cells by miR-212-3p/CBLL1 axis. These findings facilitated our understanding of lncRNA regulation in NSCLC.

Genetic profile of naïve untreated primary cutaneous melanomas with a negative sentinel lymph node

Sentinel lymph node (SLN) biopsy is typically offered to patients with primary cutaneous melanomas (PCMs) of ≥ 1 mm depth, but not all SLNs are positive using this cutoff. To ascertain whether positivity is genetically regulated, genetic analysis was performed using an augmented enrichment-based next-generation DNA and RNA sequencing assay in SLN-negative (Group 1, n = 8, mean depth 1.3 mm) and SLN-positive PCMs (controls, Group 2, n = 4, mean depth 1.4 mm). In Group 1, the mean number of mutations was 21 (range 3-48) with the most frequent mutations occurring in NF1 (75%) followed by TP53 (63%), CDKN2A and BRAF (38%), and NRAS (25%), while in Group 2, the ean number of mutations was 9.5 (range 5-18) with mutations in NRAS and BRAF being the most frequent (50%) followed by those in ATM, CDKN2A, CDKN2B, and NOTCH1 (25%). Increased frequency of NF1-inactivating mutations in Group 1 provides provocative early data that the presence of NF1 mutations might confer a less aggressive phenotype.

Discovery of Prenyltransferase Inhibitors with In Vitro and In Vivo Antibacterial Activity

Cis-prenyltransferases such as undecaprenyl diphosphate synthase (UPPS) and decaprenyl diphosphate synthase (DPPS) are essential enzymes in bacteria and are involved in cell wall biosynthesis. UPPS and DPPS are absent in the human genome, so they are of interest as targets for antibiotic development. Here, we screened a library of 750 compounds from National Cancer Institute Diversity Set V for the inhibition of Mycobacterium tuberculosis DPPS and found 17 hits, and then IC₅₀s were determined using dose-response curves. Compounds were tested for growth inhibition against a panel of bacteria, for in vivo activity in a Staphylococcus aureus/Caenorhabditis elegans model, and for mammalian cell toxicity. The most active DPPS inhibitor was the dicarboxylic acid redoxal (compound 10), which also inhibited undecaprenyl diphosphate synthase (UPPS) as well as farnesyl diphosphate synthase. 10 was active against S. aureus, Clostridiodes difficile, Bacillus anthracis Sterne, and Bacillus subtilis, and there was a 3.4-fold increase in IC₅₀ on addition of a rescue agent, undecaprenyl monophosphate. We found that 10 was also a weak protonophore uncoupler, leading to the idea that it targets both isoprenoid biosynthesis and the proton motive force. In an S. aureus/C. elegans in vivo model, 10 reduced the S. aureus burden 3 times more effectively than did ampicillin.

Evaluation of European Society of Cardiology (ESC) 0/1-hour algorithm in the diagnosis of 90-day major adverse cardiovascular events: a multicenter United States cohort study

Background

The ESC 0/1-hour algorithm using high sensitivity troponin (ESC 0/1-h) is a rapid triage protocol for diagnosing acute coronary syndrome, however the classification performance of the algorithm in the US population is uncertain. Further, evidence for the use of ESC 0/1-h in the long-term diagnosis of major adverse cardiovascular events (MACE) remains limited.

Purpose

To evaluate the performance of the ESC 0/1-h algorithm in diagnosing 90-day MACE in a diverse US cohort.

Methods

In this prospective, multicenter, observational cohort study, adult emergency department patients who were evaluated for suspected ACS were enrolled at eight sites in the US. Serial 1-hour blood samples were collected and high sensitivity troponin T (hs-cTnT) concentrations were measured in a central laboratory using the hs-cTnT assay. Primary outcome included major adverse cardiovascular events (MACE) within 90 (+30) days of enrollment. MACE defined as myocardial infarction (MI), cardiovascular or uncertain death, and coronary revascularization. Presence of MI and cardiovascular death were adjudicated by independent reviewers blinded to hs-cTnT results. Each participant was stratified to one of three risk groups as determined by ESC 0/1-h algorithm. Diagnostic classification performance metrics with exact confidence intervals (i.e. negative predictive value [NPV], positive predicted value [PPV], sensitivity, and specificity) were evaluated for each risk group where appropriate.

Results

Among 1430 eligible participants, 45.8% (655/1430) were women and 36.6% (524/1430) were African American with a mean age of 57.6±12.8 years. MACE at 90-days occurred in 15.5% (221/1430). ESC 0/1-h stratified 59.5% (851/1430) subjects in Rule-Out range and 13.0% (186/1430) subjects in Rule-In range. The Rule-Out criteria had an NPV and sensitivity for 90-day MACE of 96.8% (95% CI: 95.4–97.9%) and 87.8% (95% CI: 82.7–91.8%), respectively. For 90-day cardiovascular death or MI, Rule-Out criteria had an NPV of 98.2% (95% CI: 97.1–99.0%) and sensitivity was 92.4% (95% CI: 87.8–95.7%). The Rule-In criteria had a PPV of 60.8% (95% CI: 53.3–67.8%) for both outcomes. Rule-In criteria had a specificity for 90-day MACE and 90-day cardiovascular death or MI of 94.0% (95% CI: 92.5–95.2%) and 94.1% (95% CI: 92.6–95.3%), respectively. Among the 27.5% (393/1430) participants classified in neither risk groups, the prevalence of 90-day MACE was 20.6% (81/393) and the prevalence of 90-day cardiovascular death or MI was 17.8% (70/393)

Conclusion

In a prospective, multicenter, US cohort, the ESC 0/1-h algorithm was unable to achieve a sufficiently high NPV to safely exclude the diagnosis of MACE within 90 days after emergency department presentation. New hs-cTn algorithms specific to the US population may be warranted.

ESC 0/1-h 90 Day Outcomes

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Roche Diagnostics

[Spatio-temporal patterns of Oncomelania hupensis snail habitats in Suzhou, Wuxi and Changzhou cities along the Taihu Lake region]

OBJECTIVE

To investigate the spatio-temporal distribution characteristics of Oncomelania hupensis snail habitats in three cities of Suzhou, Wuxi and Changzhou along the Taihu Lake region, so as to provide technical supports for establishing a sensitive and highly effective surveillance and forecast system for schistosomiasis.

METHODS

Snail distribution data were collected from Suzhou, Wuxi and Changzhou cities from 1950 to 2018, and the changing trend for snail habitats were described over years. In addition, the clusters of snail habitats were detected using Kernel density analysis and SaTScan space-time scan analysis.

RESULTS

The number of snail habitats appeared a single-peak distribution in Suzhou, Wuxi and Changzhou cities from 1950 to 2018, which peaked in 1970 and then declined rapidly. There were 62.68% of snail habitats eliminated within 10 years after identification, of which 38.24% were eliminated at the year of identification. Kernel density analysis and SaTScan space-time scan analysis revealed that high-density clusters of snail habitats were mainly distributed in Kunshan City, Wuzhong District and Xiangcheng District from 1970 to 1980, and in Yixing City in 1990; since then, the clusters gradually shrank, and overall appeared a move from northeast to west of Taihu Lake. A total of 4 new clusters were detected after 1970, as revealed by space-time scanning of snail habitats. In current snail habitats, emerging snail habitats are mainly identified in Huqiu District (Dongzhu Town), Wuzhong District (Guangfu Town), Taicang City (Shaxi Town) and Jintan District, and re-emerging snail habitats are scattered in 7 districts.

CONCLUSIONS

The distribution of snail habitats are spatio-temporal aggregation in Suzhou, Wuxi and Changzhou cities. The monitoring and prediction of emerging and re-emerging snail habitats are the key points in the future.

LncRNA MAGI2-AS3 suppresses the proliferation and invasion of non-small cell lung carcinoma through miRNA-23a-3p/PTEN axis

OBJECTIVE

To uncover the biological role of long non-coding RNA (lncRNA) MAGI2-AS3 in the progression of non-small cell lung carcinoma (NSCLC) and its molecular mechanism.

PATIENTS AND METHODS

LncRNA MAGI2-AS3 level in NSCLC tissues and cell lines was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Chi-square test was conducted to analyze the correlation between MAGI2-AS3 level and pathological characteristics of NSCLC patients. Survival analysis was performed in NSCLC patients with high expression or low expression of MAGI2-AS3. In vitro influences of MAGI2-AS3 on viability and invasive ability of A549 and PC9 cells were evaluated. MicroRNA-23a-3p (miRNA-23a-3p), the target gene of MAGI2-AS3 was determined through the dual-luciferase reporter gene assay. In a similar way, the target gene of miRNA-23a-3p was identified. Finally, the regulatory effect of MAGI2-AS3/miRNA-23a-3p/PTEN (gene of phosphate and tension homology deleted on chromosome ten) axis on cellular behaviors of NSCLC cells was assessed.

RESULTS

LncRNA MAGI2-AS3 was downregulated in NSCLC tissues and cell lines. Its level was closely related to tumor size, Tumor Node Metastasis (TNM) stage and distant metastasis of NSCLC patients. The worse prognosis was identified in NSCLC patients with low expression of MAGI2-AS3 relative to those with a high expression. Overexpression of MAGI2-AS3 markedly attenuated viability and invasive ability of A549 and PC9 cells. MiRNA-23a-3p was verified to be the target gene of MAGI2-AS3, and furthermore, PTEN was the target of miRNA-23a-3p. Overexpression of miRNA-23a-3p could reverse the inhibited viability and invasion in NSCLC cells overexpressing MAGI2-AS3.

CONCLUSIONS

MAGI2-AS3 is downregulated in NSCLC. Overexpression of MAGI2-AS3 suppresses the proliferative and invasive abilities of NSCLC via miRNA-23a-3p/PTEN axis.

Synaptic Plasticity After Focal Cerebral Ischemia Was Attenuated by Gap26 but Enhanced by GAP-134

Objective: Synaptic plasticity is critical for neurorehabilitation after focal cerebral ischemia. Connexin 43 (Cx43), the main component of the gap junction, has been shown to be pivotal for synaptic plasticity. The objective of this study was to investigate the role of the Cx43 inhibitor (Gap26) and gap junction modifier (GAP-134) in neurorehabilitation and to study their contribution to synaptic plasticity after focal ischemia. Methods: Time course expression of both total and phosphorylated Cx43 (p-Cx43) were detected by western blotting at 3, 7, and 14 d after focal ischemia. Gap26 and GAP-134 were administered starting from 3 d post focal ischemia. Neurological performances were evaluated by balance beam walking test and Y-maze test at 1, 3, and 7 d. Golgi staining and transmission electron microscope (TEM) detection were conducted at 7 d for observing dendritic spine numbers and synaptic ultrastructure, respectively. Immunofluorescent staining was used at 7 d for detection of synaptic plasticity markers, including synaptophysin (SYN) and growth-associated protein-43 (GAP-43). Results: Expression levels of both total Cx43 and p-Cx43 were increased after focal cerebral ischemia, peaking at 7 d. Compared with the MCAO group, Gap26 worsened the neurological behavior and decreased the dendritic spine number while GAP-134 improved the neurobehavior and increased the number of dendritic spines. Moreover, Gap26 further destroyed the synaptic structure, concomitant with downregulated SYN and GAP-43, whereas GAP-134 alleviated synaptic destruction and upregulated SYN and GAP-43. Conclusion: These findings suggested that Cx43 or the gap junction was involved in synaptic plasticity, thereby promoting neural recovery after ischemic stroke. Treatments enhancing gap junctions may be potential promising therapeutic measures for neurorehabilitation after ischemic stroke.

[Establishment of the gene detection method of Schistosoma mansoni based on the recombinase-aided isothermal amplification assay]

OBJECTIVE

To establish a recombinase-aided isothermal amplification (RAA) assay for nucleic acid detection of Schistosoma mansoni.

METHODS

The 121 bp highly-repeated sequence of S. mansoni was selected as the target gene fragment to be detected. The primers and fluorescent probes were designed using the Amplfix software, and a fluorescent RAA assay was established and optimized. The fluorescent RAA assay was performed to detect gradient diluent recombinant plasmids containing target gene fragment and different concentrations of S. mansoni genomic DNA to determine the sensitivity, and this assay was applied to detect the genomic DNA of S. japonicum, S. haematobium, Ancylostoma duodenale and Clonorchis sinensis to evaluate the specificity.

RESULTS

A fluorescent RAA assay was successfully established, which was effective to amplify the specific gene fragments of S. mansoni within 20 min at 39 ℃. The minimum detectable limit of the fluorescent RAA assay was 10 copies/μL using recombinant plasmids as templates and 0.1 fg/μL using S. mansoni genomic DNA samples as templates. The fluorescent RAA assays were all negative for detecting the genomic DNA from S. japonicum, S. haematobium, A. duodenale and C. sinensis.

CONCLUSIONS

A novel fluorescent RAA assay is successfully established, which is simple, rapid, sensitive and specific to detect genomic DNA of S. mansoni.

LncRNAp21 promotes osteogenic differentiation of mesenchymal stem cells in the rat model of osteoporosis by the Wnt/β-catenin signaling pathway

OBJECTIVE

The aim of this study was to explore the promoting effect of long non-coding ribonucleic acid p21 (lncRNAp21) on the osteogenic differentiation of mesenchymal stem cells in the rat model of osteoporosis (OP) through the Wnt/β-catenin signaling pathway.

MATERIALS AND METHODS

A total of 30 healthy female rats were selected and randomly divided into three groups, including the lncRNAp21 group, OP model group (model group) and normal group. Rats in the lncRNAp21 group were given a certain quantity of lncRNAp21 inhibitors for gavage. Rats in the model group were regularly given 0.9% NaCl for gavage every day after the removal of bilateral ovaries. Meanwhile, rats in the normal group were fed normally without any changes. Bone mineral density (BMD) was measured after 12 weeks of modeling. The levels of procollagen type I N-terminal propeptide (PINP), serum estradiol (E2), osteocalcin (OC), bone alkaline phosphatase (BALP), C-terminal cross-linking telopeptide of type I collagen (CTX) and tartrate-resistant acid phosphatase 5b (TRACP-5b) in the bone and serum of rats were measured by enzyme-linked immunosorbent assay (ELISA). Besides, quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blotting were adopted to detect the mRNA and protein expressions of Wnt1 and β-catenin in bone tissues, respectively.

RESULTS

Compared with the normal group and lncRNAp21 group, the serum level of E2 in the model group decreased significantly (p<0.05). BMD and phosphorus (P) content in the model group were both markedly lower than those of the normal group and lncRNAp21 group. However, calcium (Ca) content was remarkably higher than that of the normal group and lncRNAp21 group (p<0.05). The serum levels of bone resorption markers (including TRACP-5b and CTX) in the model group were prominently higher than those of the normal group (p<0.05). However, the levels of the two markers in the lncRNAp21 group were significantly lower than the model group (p<0.05). Additionally, bone formation markers (including OC, PINP and BALP) in the serum of rats in the model group were notably higher than those in the normal group and lncRNAp21 group (p<0.05). QRT-PCR and Western blotting results revealed that the mRNA and protein expressions of Wnt1 and β-catenin in bone tissues of the model group were markedly lower than those of the normal group. However, the mRNA and protein expressions of Wnt1 and β-catenin in the lncRNAp21 group were remarkably higher than the model group (p<0.05).

CONCLUSIONS

Low expression of lncRNAp21 activates the Wnt/β-catenin signaling pathway by increasing E2 secretion, eventually stimulating bone formation and increasing osteogenic differentiation of mesenchymal stem cells in OP model rats.

[Progresses of research on patterns and monitoring approaches of Oncomelania hupensis spread]

Oncomelania snail is the only intermediate host of Schistosoma japonicum, and controlling snail breeding and spread is an important intervention for schistosomiasis control. This review summarizes factors affecting snail spread, characteristics of snail spread in various endemic areas, high-risk environments of snail spread and monitoring methods of snail spread, so as to provide insights into the prevention of snail spread.

FRI0179 A STUDY ON THE ACHIEVEMENT OF LUPUS LOW DISEASE ACTIVITY STATE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: FROM THE JUNTENDO UNIVERSITY SLE PROSPECTIVE REGISTRY STUDY

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that affects mostly young women. Multiorgan complications and prolonged treatment significantly cause physical and mental stress in patients. Improving patients’ quality of life (QOL) in SLE treatment is essential. We examined the treatment effects on disease activity and QOL of SLE patients.

Objectives:

In recent years, lupus low disease activity state (LLDAS) has been proposed as a treatment target for SLE. Patients who achieve LLDAS have a low recurrence rate for lupus and a low risk of serious complications (1). The aim of this study is to investigate whether achieving LLDAS reduces not only recurrence rate and complications of SLE but also improves patients’ QOL.

Methods:

A total of 104 SLE patients were enrolled in our prospective SLE registry study (Juntendo, Multi-center, Prospective cohort for investigation of clinical course and outcome in SLE: JUMP) conducted at our institution. SLE was diagnosed using the American College of Rheumatology (ACR) 1982 criteria (revised in 1997). QOL was evaluated using the standard version of the 36-item short form health survey version 2 (SF36v2). Participants were divided into the LLDAS achievement and non-achievement groups, and the characteristics of each group including results of SF36v2 were examined.

Results:

This study included 104 SLE patients, 94 female and 10 male, and the average age and disease duration were 46.4±13.8 and 14.5±11.3 years, respectively. The average corticosteroid dose was 8.0±17.4 mg/day in terms of prednisolone, and anti-dsDNA antibody titer was 16.8±38.5 IU/ml. Of the 104 patients, 57 achieved LLDAS. The subscale’s standard scoring using SF36v2 for role physical (RP) was 78.9±24.0 and 64.6±27.6 (P<0.01), general health (GH) was 50.0±17.0 and 42.0±19.3 (P<0.05), vitality (VT) was 55.8±15.8 and 38.0±24.1 (P<0.01), social functioning (SF) was 82.0±20.7 and 66.5±26.3 (P<0.01), role emotional (RE) was 89.0±16.1 and 73.4±28.1 (P<0.01), and mental health (MH) was 72.4±15.9 and 58.3±21.8 (P<0.01) in the LLDAS achievement and non-achievement groups, respectively. Furthermore, scoring based on the national standard value in the LLDAS achievement group showed that two categories were >50. However, in the LLDAS non-achievement group, all categories were <50. In particular, RP, GH, VT, SF, RE, and MH of the LLDAS achievement group had significantly higher scores than the LLDAS non-achievement group (RP and GH: p<0.05 and VT, SF, RE and MH: p<0.01).

Conclusion:

Results of examining the association between LLDAS and QOL using SF36v2 in SLE patients showed that patients who achieved LLDAS had significantly better standard statistical scores in many subscale categories. Thus, LLDAS achievement as a treatment target for SLE patients greatly contributes to improving patients’ QOL.

References:

[1]Franklyn K, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS).Ann Rheum Dis. 2016 Sep;75(9):1615-21.

Disclosure of Interests:

None declared

0586 Advanced Tree Models to Predict Moderate-to-Severe Obstructive Sleep Apnea

Introduction

The aim of this study was to develop a predicting model for the moderate-to-severe obstructive sleep apnea (OSA) by using advanced tree models.

Methods

We retrospectively investigated the medical records of patients who undertaken overnight polysomnography (PSG) at our sleep disorders center. We divided the data to a training set (70%) and a test set (30%), randomly. We made a random forest and a XGBoost model to predict the moderate-to-severe OSA (apnea hyponea index [AHI] ≥ 15/h) by using the training set, and then applied each models to the test set. To compare the fitness of the models, we used an accuracy, and an area under curve (AUC).

Results

Finally, 1,426 patients (AHI &lt; 5:AHI ≥ 15= 464:962) were enrolled. The random forest model showed an accuracy of 0.79, and AUC of 0.82. In the random forest model, the sleep apnea scale of the sleep disorders questionnaire (SA-SDQ), age, neck circumference, male sex, body mass index (BMI), hypertension, and hyperlipidemia appeared in order of a variance importance. The XGBoost model showed an accuracy of 0.75 and AUC of 0.79.

Conclusion

The random forest model to predict moderate-to-severe OSA showed better performance compared to the XGBoost model. The further study for validation is required.

Support

None

0935 Association Between Chronotype, Sleep Duration, Weekend Catch-Up Sleep, and Depression Among Korean High School Students

Introduction

The present study aimed to examine the association between chronotype, sleep duration, weekend catch-up sleep (CUS) duration, and depression among Korean high school students.

Methods

A total of 8,565 high school students who were analyzed from 15 nationwide districts in South Korea completed an online self-report questionnaire. Depressive mood was assessed using the Korean version of the Beck Depression Inventory. The following sleep characteristics were assessed: weekday and weekend sleep durations, weekend CUS duration, chronotype, perceived sufficiency of sleep, self-reported snoring and sleep apnea, daytime sleepiness, and sleep environment. Age, sex, body mass index, number of private classes, and proneness to internet addiction were also measured. Logistic regression analysis was conducted to compute odds ratios for the association between depression and sleep characteristics, after controlling for relevant covariates.

Results

The prevalence of depression (BDI ≥ 16) was 1,794 (20.9%). In the analyses of multivariate logistic regression, the late chronotype (odds ratio [OR], 1.71; 95% CI, 1.47-1.99), female (OR, 2.24; 95% CI, 1.99-2.53), underweight (OR, 1.27; 95% CI, 1.02-1.57) and obesity (OR, 1.41; 95% CI, 1.13-1.75), weekday sleep duration (OR, 0.86; 95% CI, 0.81-0.91), weekend CUS duration ≥ 2 hours (OR, 0.68; 95% CI, 0.55-0.85), ESS (OR, 1.08; 95% CI, 1.07-1.10), much (OR, 2.15; 95% CI, 1.63-2.84) and insufficient (OR, 1.71; 95% CI, 1.46-2.01) perceived sleep, snoring (OR, 1.27; 95% CI, 1.11-1.46) and witnessed apnea (OR, 2.10; 95% CI, 1.75-2.52), increased internet addiction (OR, 1.06; 95% CI, 1.05-1.06), high number of private education (OR, 0.76; 95% CI, 0.60-0.95), and poor sleep environment (OR, 1.86; 95% CI, 1.56-2.21) were associated with depression.

Conclusion

Eveningness preference, insufficient weekday sleep duration, short weekend CUS duration, and self-reported snoring and sleep apnea were associated with an increased risk for depression.

Support

 

FBW7 inhibits nucleus pulposus cells proliferation by downregulation of cyclin E in the intervertebral disc degeneration

The article "FBW7 inhibits nucleus pulposus cells proliferation by downregulation of cyclin E in the intervertebral disc degeneration, by J.-W. Xu, J. Wang, K. Yang, S. Guo, C.-S. Feng, H.-Y. Chen, H.-P. Li, published in Eur Rev Med Pharmacol Sci 2020; 24(2):508-516. DOI: 10.26355/eurrev_202001_20026. PMID: 32016952" has been withdrawn from the authors. The Publisher apologizes for any inconvenience this may cause.

[Effect of standardized surgical treatment and multidisciplinary treatment strategy on the prognosis of gastric cancer patients: report of a single-center cohort study]

Objective: To explore the effect of standardized surgical treatment and multidisciplinary treatment strategy on the treatment outcomes of gastric cancer patients. Methods: A single-center cohort study was carried out. Clinicopathological and long-term follow up data of primary gastric cancer patients were retrieved from the database of Surgical Gastric Cancer Patient Registry (SGCPR) in West China Hospital of Sichuan University. Finally, 4516 gastric cancer patients were included and were divided into three groups according to time periods (period 1 group: exploration stage of standardized surgical treatment, 2000 to 2006, 967 cases; period 2 group: application stage of standardized surgical treatment, 2007 to 2012, 1962 cases; period 3 group: optimization stage of standardized surgical treatment and application stage of multidisciplinary treatment strategy, 2013 to 2016, 1587 cases). Differences in clinical data, pathologic features, and prognosis were compared among 3 period groups. Follow-up information was updated to January 1, 2020. The overall follow-up rate was 88.9% (4016/4516) and median follow-up duration was 51.58 months. Survival curve was drawn by Kaplan-Meire method and compared with log-rank test. Univariate and multivariate analyses were performed by Cox proportional hazards model. Results: There were significant differences among period 1, period 2 and period 3 groups in the rates of D2/D2+ lymphadenectomy [14.4%(139/967) vs. 47.2%(927/1962) vs. 75.4%(1197/1587), χ(2)=907.210, P<0.001], in the ratio of proximal gastrectomy [19.8%(191/967) vs. 16.6%(325/1962) vs. 8.2%(130/1587), χ(2)=100.020, P<0.001], and in the median intraoperative blood loss (300 ml vs. 100 ml vs. 100 ml, H=1126.500, P<0.001). Besides, the increasing trend and significant difference were also observed in the median number of examined lymph nodes among period 1, period 2 and period 3 groups (14 vs. 26 vs. 30, H=987.100, P<0.001). Survival analysis showed that the 5-year overall survival rate was 55.3% in period 1, 55.2% in period 2 and 62.8% in period 3, and significant difference existed between period 3 and period 1 (P=0.004). The Cox proportional hazards model analysis showed that treatment period (period 3, HR=0.820, 95%CI: 0.708 to 0.950, P=0.008), postoperative chemotherapy (HR=0.696, 95%CI: 0.631 to 0.768, P<0.001) and mid-low gastric cancer (HR=0.884, 95%CI: 0.804 to 0.973, P=0.011) were good prognostic factors. Whereas old age (≥65 years, HR=1.189, 95%CI: 1.084 to 1.303, P<0.001), palliative resection (R1/R2, HR=1.538,95%CI: 1.333 to 1.776, P<0.001), large tumor size (≥5 cm, HR=1.377, 95%CI: 1.239 to 1.529, P<0.001), macroscopic type III to IV (HR=1.165, 95%CI: 1.063 to 1.277, P<0.001) and TNM stage II to IV(II/I:HR=1.801,95%CI:1.500~2.162,P<0.001;III/I:HR=3.588, 95%CI: 3.028~4.251, P<0.001; IV/I: HR=6.114, 95%CI: 4.973~7.516, P<0.001) were independent prognostic risk factors. Conclusion: Through the implementation of standardized surgical treatment technology and multidisciplinary treatment model, the quality of surgery treatment and overall survival increase, and prognosis of gastric cancer patients has been improved.

The effectiveness and safety of thromboprophylaxis in cancer patients based on Khorana score: a meta-analysis and systematic review of randomized controlled trials

INTRODUCTION

Cancer patients receiving chemotherapy are a high risk of VTE, yet the importance of thromboprophylaxis for cancer patients that are at high risk of developing VTE is still controversial.

AIM

To calculate the benefits and harms of thromboprophylaxis, compared to placebo, in ambulatory high-risk cancer patients that are receiving chemotherapy.

METHODS

We searched PubMed, Embase, Web of Science, the Cochrane Library, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, WANFANG Data, Chinese National Knowledge Infrastructure and Chinese Scientific Journal Database for randomized controlled trials (RCTs) describing benefits and harms of thromboprophylaxis. Statistical analysis was performed using Stata software (version 15.1).

RESULTS

We included six studies, which contained a total of 3240 cancer patients with thromboprophylaxis and 2874 cancer patients without thromboprophylaxis. Thromboprophylaxis was effective in high-risk patients with two points or higher (RR 0.51, 95% CI 0.36-0.71, I² = 0.0%, P = 0.526). It was associated with an increase in bleeding events (RR 1.65, 95% CI 1.14-2.40, I² = 0.0%, P = 0.498) and was mainly efficient in reducing the risk of pulmonary embolism (RR 0.56, 95% CI 0.33-0.96, I² = 0.0%, P = 0.263). The risk of major (RR 1.85, 95% CI 0.87-3.94, I² = 0.0%, P = 0.888) and non-major (RR 1.59, 95% CI 0.96-2.62, I² = 16.3%, P = 0.303) bleeding showed no significant difference with or without thromboprophylaxis. There was no reduction in all-cause mortality with thromboprophylaxis (RR 0.95, 95% CI 0.78-1.18, I² = 22.0%, P = 0.277).

CONCLUSION

Thromoboprophylaxis is effective and safe in cancer patients that are at high risk for developing VTE with chemotherapy.

[Spatio-temporal distribution of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal]

OBJECTIVE

To explore the spatio-temporal characteristics of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, so as to provide scientific evidence for the dynamic assessment of the risk of snail spread in this region.

METHODS

O. hupensis snail status was collected in the plain regions with waterway networks in the study area from 2012 to 2017. The spatio-temporal variations of snail distribution were investigated along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal using buffer zone analysis, spatial autocorrelation, hotspot analysis and standard deviational ellipse with the geographical information system (GIS) tools.

RESULTS

The number of snail habitats showed a tendency towards a rise in the study area from 2012 to 2017, and snail habitats were predominantly distributed in the 1 000 m long buffer zone of the Danyang-Jintan-Liyang Canal, notably along the Jiuqu River at the junction between the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal. The distribution of snail habitats appeared spatial autocorrelations in 2014, 2016 and 2017, and the hotspot areas were mainly identified at the junction between the Danyang-Jintan-Liyang Canal and the Beijing-Hangzhou Grand Canal. In addition, the overall distribution of snail habitats was located in the northeastern-southwestern part of the study aera, and gradually shifted to the southern and northern parts with the time.

CONCLUSIONS

The spatial distribution of O. hupensis snails is complex along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, and there is a risk of snail spread from the upper reaches to the lower reaches, where snail control needs to be intensified.

[Progress of interruption of schistosomiasis transmission in Jiangsu Province]

Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of "implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions", an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

[Status of grass-roots schistosomiasis control professionals in Jiangsu Province: a cross-sectional study]

OBJECTIVE

To understand the status of grass-roots schistosomiasis control professionals in Jiangsu Province, so as to provide scientific evidence for the rational resource allocation and the improvement of capability building.

METHODS

A cross-sectional survey was conducted by telephone interview and e-mail among city- and county-level disease prevention and control institutions that undertook schistosomiasis control activities in Jiangsu Province, and the age, educational background, major, duration of working, professional title and professional capability were descriptively analyzed.

RESULTS

There were totally 274 fulltime schistosomiasis control professionals working at grass-roots institutions in Jiangsu Province, with a mean age of (43.19 ± 9.47) years. The least professionals were below 30 years of age (12.77%, 35/274), and the most professionals were aged from 41 to 50 years (36.86%, 101/274). Among the 274 professionals, 43.07% (118/274) had duration of working of less than 10 years, 62.04% (170/274) had a bachelor degree, and 40.88% (112/274) had the medium-level professional title.

CONCLUSIONS

A schistosomiasis control team with a relatively high academic degree and professional title has been built at the grassroot level in Jiangsu Province. However, capability building remains to be improved through the participation of more young professionals and professional training with adaptation to local conditions.

FBW7 inhibits nucleus pulposus cells proliferation by downregulation of cyclin E in the intervertebral disc degeneration

OBJECTIVE

TF-box and WD repeat domain-containing 7 (FBW7), a component of SCF ubiquitin ligase complex, usually acts as a tumor suppressor because it has an ability in the inhibition of cell proliferation. Nevertheless, the role of FBW7 in intervertebral disc degeneration (IDD) is not quite understood.

MATERIALS AND METHODS

The total protein and RNA were isolated from patients' disc tissues. WB was carried out to analyze the collagen II and FBW7 protein levels of different Pfirrmann grades disc degeneration. Reverse transcription-polymerase chain reaction (RT-PCR) was used to test the collagen II and FBW7 mRNA expression in these disc samples. NP cells were transfected with siRNA-FWB7 to downregulate the FBW7 expression. SiRNA-NC was used as the sham group. Cyclin E, E2F1, and E2F2 were analyzed with WB and RT-PCR.

RESULTS

In this study, different kinds of degenerated disc tissues were analyzed, and it was found that FBW7 was overexpressed in much severe degeneration condition, which was also proved by the IL-1β stimuli nucleus pulposus (NP) cells degeneration model in vitro. Interestingly, the results showed that FBW7 suppression could reverse the degeneration of NP cells. Furthermore, we found that FBW7 induced NP cell cycle arrest in the G1 phase of and inhibited cell proliferation by upregulating p27 expression in vitro. The overexpression of p27 resulted in the inhibition of cyclin E, which promotes cell proliferation.

CONCLUSIONS

Taken together, our study uncovered that FBW7 played an essential inhibitory role in NP cells proliferation, providing new insights that FBW7 may be a potential strategy for IDD treatments.

Expression and distribution of HIF-1α, HIF-2α, VEGF, VEGFR-2 and HIMF in the kidneys of Tibetan sheep, plain sheep and goat

BACKGROUND

The objective of this study was to detect the expression and distribution characteristics of five proteins (the hypoxia-inducible factor 1alpha [HIF-1a], HIF-2a, vascular endothelial growth factor [VEGF], VEGF-2 receptor [VEGFR-2] and hypoxia-induced mitogenic factor [HIMF]) in kidney of Tibetan sheep, plain sheep and goat. The results will provide the basic information for the comparative study of sheep breeds living at different altitudes.

MATERIALS AND METHODS

The kidney tissues were collected from healthy adult Tibetan sheep, plain sheep and goats and made into paraffin sections. Histological characteristics were assessed by haematoxylin and eosin staining. Expressions of HIF-1a, HIF-2a, VEGF, VEGFR-2 and HIMF proteins were measured by immunohistochemical staining.

RESULTS

Immunohistochemistry results showed that the positive expression signals of HIF-1a, HIF-2a, VEGF and VEGFR-2 were detected in epithelial cells of renal tubules and collecting tubules, renal corpuscles in the kidneys of the three sheep breeds. Positive expression signals of HIMF were detected in epithelial cells of proximal tubules and distal tubules in Tibetan sheep and epithelial cells of distal tubules in goat. Immunostaining intensity of HIF-1a, HIF-2a, VEGF and VEGFR-2 proteins in Tibetan sheep was significantly higher than that in both plain sheep and goat (p < 0.05). Immunostaining intensity of HIMF in Tibetan sheep was higher than goat (p < 0.05). Positive expression signals of HIMF were not detected in plain sheep.

CONCLUSIONS

The expression and distribution characteristics of HIF-1a, HIF-2a, VEGF, VEGFR-2 and HIMF in the studied kidney tissues suggested that these proteins may be related to the physiological regulation of Tibetan sheep kidney in hypoxia environment, and therefore might be important regulating proteins for Tibetan sheep to adapt to high altitude hypoxia environment.

[Application value of a dynamic automatic identification system in Schistosoma japonicum miracidium hatching test]

OBJECTIVE

To evaluate the value of a dynamic automatic identification system in routine miracidium hatching test with nylon gauzes.

METHODS

Different quantities of fresh Schistosoma japonicum eggs were added to bovine fecal samples and divided into the low-infection group, medium-infection group and high-infection group, while the bovine feces without S. japonicum eggs served as negative controls. The detection efficiency and accuracy were compared between the identification system and manual detection in different groups.

RESULTS

The identification system can automatically identify S. japonicum miracidium. The detection rate and efficiency of S. japonicum miracidium in bovine fecal samples were both higher by using the identification system than by manual detection. Notably in the low-infection group, the identification system had a significantly higher rate of detection of S. japonicum miracidium than manual detection (χ² = 10.769, P = 0.002). The identification system completed the detection of bovine fecal samples in the field within 1 min.

CONCLUSIONS

The dynamic automatic identification system may effectively improve the detection efficiency and accuracy of routine miracidium hatching test with nylon gauzes, and it may replace manual detection to be used in the field schisotsomiasis examinations and related researches.

[Endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018]

OBJECTIVE

To analyze and investigate the changing trend of the endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018, so as to provide scientific evidence for formulating strategies for schistosomiasis control.

METHODS

From 2011 to 2014, the national schistosomiasis surveillance sites were set in seven schistosomiasis endemic counties (cities, districts) across Jiangsu Province as according to the National Schistosomiasis Surveillance Scheme (2011 version), and from 2015 to 2018, the national surveillance sites were assigned in all 64 counties (cities, districts) endemic for schistosomiasis in Jiangsu Province according to the National Schistosomiasis Surveillance Scheme (2014 version). Schistosoma japonicum infections in local populations, mobile populations and livestock, and snail status were monitored in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and the monitoring data were statistically analyzed.

RESULTS

The sero-prevalence of S. japonicum infections was 1.50% to 4.61% among local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and a higher sero-prevalence was seen in men than in women, with the sero-positives predominantly detected in local populations at ages of over 50 years. The positive rate of stool examinations was 0 to 0.14% among sero-positive local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no acute case was found in local populations during the study period. The sero-prevalence of S. japonicum infections was 0.46% to 15.97% among mobile populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no egg-positives were identified. A total of 1 453 livestock were tested in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no S. japonicum infections were detected. During the period from 2011 through 2018, snail survey was conducted in an area of 216 million m² in the national schistosomiasis surveillance sites of Jiangsu Province, and 1 291.01 hm² snail habitats were identified, with snail densities ranging from 0.01 to 0.47 snails/0.1 m²; however, no S. japonicum infections were identified in snails.

CONCLUSIONS

The overall endemic situation of schistosomiasis appears a tendency towards a decline in Jiangsu Province, and S. japonicum infection remains at a low level in both humans and livestock. No S. japonicum infection has been identified in local populations in Jiangsu Province since 2012. In the future, monitoring and management of imported sources of S. japonicum infections should be intensified in Jiangsu Province, and the capability building of passive surveillance of schistosomiasis should be improved in sentinel hospitals in national schistosomiasis surveillance sites of Jiangsu Province. In addition, the examination of schistosomiasis should be strengthened in mobile populations in Jiangsu Province, a sensitive and effective surveillance-response system for schistosomiasis is urgently needed.

[Establishment and operation of schistosomiasis diagnostic reference laboratory in Jiangsu Province]

OBJECTIVE

To construct the schistosomiasis diagnostic reference laboratory in Jiangsu Province, and to examine the role and diagnostic efficiency of the reference laboratory.

METHODS

A schistosomiasis diagnostic reference laboratory was built in Jiangsu Province according to the requirements of the construction of the national schistosomiasis diagnostic reference laboratory in China. Inter-laboratory comparisons were conducted and the diagnostic capability of grassroots laboratories was evaluated in Jiangsu Province.

RESULTS

The organization structure, environmental conditions, administration and quality systems of the schistosomiasis diagnostic reference laboratory in Jiangsu Province all met the requirements for construction of the national schistosomiasis diagnostic reference laboratory in China, and the schistosomiasis diagnostic reference laboratory in Jiangsu Province was issued a certificate of a province-level schistosomiasis diagnostic reference laboratory. During the 6 inter-laboratory comparisons performed by national schistosomiasis diagnostic reference centers of China, the qualitative and quantitative results of each detection item were all in agreement with the reference samples (Kappa = 1), and the diagnostic capability was identified excellent. The results of indirect hemagglutination assay of 426 serum samples from 4 grassroots laboratories were re-examined, and the mean coincidence rate was 94.13% (range, 92.08% to 96.25%) with the grassroots laboratories, with a mean Kappa value of 0.85 (range, 0.83 to 0.86) and a mean missing rate of 10.19% (range, 0 to 17.65%).

CONCLUSIONS

The schistosomiasis diagnostic reference laboratory has been successfully established and effectively operated in Jiangsu Province, which plays an active role in improving the capability of schistosomiasis diagnostic equality in the province.

[Spatio-temporal analysis of Oncomelania hupensis along Jiangsu section of the Yangtze River from 2015 to 2017]

OBJECTIVE

To investigate the spatio-temporal characteristics of Oncomelania hupensis snails along the Jiangsu section of the Yangtze River, so as to provide evidence for eliminating schistosomiasis and formulating precision control measures in Jiangsu Province.

METHODS

A total of 75 marshlands were randomly sampled from Nanjing, Zhenjiang and Yangzhou cities along the Jiangsu section of the Yangtze River basin, and the spatio-temporal distribution and changing patterns of O. hupensis snails were investigated using the spatial autocorrelation analysis, kernel density analysis and hotspot analysis during the period from 2015 through 2017.

RESULTS

There was a spatial autocorrelation in the mean snail density along the Jiangsu section of the Yangtze River basin during the period from 2015 through 2017. The number of living snails and the density of living snails showed an overall decline in Yangzhou City; however, both showed a slight increase in 2016. Kernel density analysis and hotspot analysis showed that the hotspots of living snails were located in the regions neighboring the marshlands at the Yangzhou-Zhenjiang boundary areas along the Jiangsu section of the Yangtze River basin.

CONCLUSIONS

There is a spatial autocorrelation in the snail distribution with hotspots along the Jiangsu section of the Yangtze River basin, and the surveillance of snails should not be neglected in the marshlands in Jiangsu Province.

[Assessing the efficiency of schistosomiasis control programs in Jiangsu Province from 2005 to 2015 using data envelopment analysis (Malmquist index method)]

OBJECTIVE

To assess the total factor productivity (TFP) of schistosomiasis control programs in Jiangsu Province, so as to provide insights into sustainable schistosomiasis control.

METHODS

The data envelopment analysis-Malmquist index method was employed to analyze the human resources and financial investments in schistosomiasis control programs from health sectors in each schistosomiasis-endemic city of Jiangsu Province from 2005 to 2015, and assess the outputs of each schistosomiasis control project.

RESULTS

The overall productive efficiency of schistosomiasis control programs in Jiangsu Province showed an increasing tendency, and the mean fluctuation of annual TFP was 2.3%. The comprehensive technical efficiency, including pure efficiency and scale efficiency, appeared a steady increase with minor fluctuations, and the mean fluctuation of annual comprehensive technical efficiency was 3.8%. The growth rate of technical progress fluctuated greatly from 2005 to 2011, and showed a steady increase from 2012 to 2015, which became a major contributor to the growth of TFP. A higher growth rate of TFP was seen in Huai ' an and Changzhou cities, which showed a greater comprehensive technical efficiency, and a large fluctuation was observed in the growth rate of technical progress in Yancheng, Nanjing, Huai ' an and Yangzhou cities.

CONCLUSIONS

There is a continuous improvement in the technical level of schistosomiasis control programs in Jiangsu Province, and technical application and supervision and management capacity also show a steady increase. In addition, the application of new techniques and new strategies contributes greatly to TFP growth. In the future, the investment into new techniques and new strategies should be increased to ensure the sustainable schistosomiasis control in Jiangsu Province.

[Current status of international discourse of China aid project of schistosomiasis control in Zanzibar]

Since the Eighteenth National Congress of the Communist Party of China, China has constantly innovated and developed its diplomatic concept, and proposed the important idea of the Community of Shared Future for Mankind (CSFM), which contributes a discourse system with Chinese characteristics to the world. It is indicated that discourse builds its subject and governs the subject's discourse practices, and the discourse subject strengthens and reiterates discourse rules in discourse practices. China aid project of schistosomiasis control in Zanzibar is a discourse subject of the CSFM discourse system. This paper analyzes the discourse status, discourse practices and the reiteration of discourse rules of China aid project of schistosomiasis control in Zanzibar.

P6449Circulating long noncoding RNA expression signature as a novel biomarker for myocardial fibrosis

Background

Cardiac fibrosis (CF) plays a critical role in the pathogenesis of heart failure (HF), predisposing to contractile dysfunction, myocardial stiffness and life-threatening arrhythmias. Early detection and intervention of myocardial fibrosis, therefore, can delay or prevent the progression of HF. Current diagnostic and treatment options for CF, however, are very limited.

Purpose

To test the hypothesis that circulating lncRNA expression signature can be a sensitive biomarker to diagnose and correlate with the extent of CF in human heart.

Methods

Plasma RNA samples from healthy control (n=23) and from patients with diffuse myocardial fibrosis documented by cardiac magnetic resonance (T1 mapping technique, n=16) were analyzed by RNA sequencing (RNASeq), followed by differential expression, gene ontology/pathway and receiver operating characteristic (ROC) curve analyses.

Results

RNASeq revealed that 439 mRNAs were differentially expressed in the plasma from patients with CF, compared to that from controls. Gene ontology analyses showed significant enrichment of these CF-linked genes in cytoskeleton organization, innate immune response, and MAPK-Erk signaling, cellular processes known to contribute to the development of CF. Further analyses showed that 84 plasma lncRNAs were dysregulated in patients with CF; 5 of the lncRNAs (ENSGehz746.10420265401.1, ENSGehz746.10420229124.6, ENSGehz746.10420281376.1, ENSGehz746.10420273275.1 and ENSGehz746.10420179818.13) showed concordant changes with their cis-mRNA (UBB, VIM, BCL2L1, PPP3R1 and PCBP1). Hierarchical clustering analyses demonstrated that the expression signature of plasma lncRNAs could distinguish patients with CF from control patients (classification accuracy 87%). The expression levels of plasma lncRNAs ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1, in particular, were markedly downregulated in patients with myocardial fibrosis. ROC curve analyses showed that low expression levels of ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1 were highly sensitive and specific to detect the presence of CF in human heart (AUC 0.9 for both lncRNAs, Figure).

LncRNA Predicts Cardiac Fibrosis

Conclusions

The present study revealed a circulating transcriptome signature that reflects the pathogenesis of CF. The expression profiles of circulating lncRNAs discriminated between patients with and without interstitial myocardial fibrosis. LncRNAs ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1, in particular, are novel biomarkers with potential to facilitate clinical diagnosis of myocardial fibrosis.

Developments in understanding and applying prebiotics in research and practice-an ISAPP conference paper

AIMS

The concept of using specific dietary components to selectively modulate the gut microbiota to confer a health benefit, defined as prebiotics, originated in 1995. In 2018, a group of scientists met at the International Scientific Association for Probiotics and Prebiotics annual meeting in Singapore to discuss advances in the prebiotic field, focussing on issues affecting functionality, research methodology and geographical differences.

METHODS AND RESULTS

The discussion ranged from examining scientific literature supporting the efficacy of established prebiotics, to the prospects for establishing health benefits associated with novel compounds, isolated from different sources.

CONCLUSIONS

While many promising candidate prebiotics from across the globe have been highlighted in preliminary research, there are a limited number with both demonstrated mechanism of action and defined health benefits as required to meet the prebiotic definition. Prebiotics are part of a food industry with increasing market sales, yet there are great disparities in regulations in different countries. Identification and commercialization of new prebiotics with unique health benefits means that regulation must improve and remain up-to-date so as not to risk stifling research with potential health benefits for humans and other animals.

SIGNIFICANCE AND IMPACT OF STUDY

This summary of the workshop discussions indicates potential avenues for expanding the range of prebiotic substrates, delivery methods to enhance health benefits for the end consumer and guidance to better elucidate their activities in human studies.

[Cardiovascular magnetic resonance imaging characteristics and influence factors of aortic insufficiency patients with myocardial fibrosis]

Objective: To investigate the cardiovascular magnetic resonance (CMR) imaging characteristics and influence factors of aortic insufficiency (AI) patients with myocardial fibrosis. Method: This retrospective study included 59 AI patients who received CMR and transthoracic echocardiography (TTE) examinations from June 2011 to February 2015. AI patients were divided into 2 groups: bicuspid aortic valve (BAV) group (n=30) and non-BAV group (n=29). Patients were also divided into late gadolinium enhancement (LGE) group (n=27) and non-LGE group (n=32). The baseline clinical characteristics were collected through electronic medical records. Hemodynamic parameters such as grade of AI, cardiac functional parameters and LGE mass fraction (LGE%) were measured by CMR post-processing analysis. Kappa test was used to assess the consistency of AI severity between CMR and TTE, and the multivariate logistic regression analysis was performed to evaluate influence factors of myocardial fibrosis in AI patients. Results: (1) 56 (94.9%) patients were male, and the mean age was (44.2±11.0) years old. There was no significant difference in age and gender, hypertension, hyperlipidemia, alcoholic consumption between BAV and non-BAV group (all P>0.05). There were a higher proportion of smoking history (P=0.008), a lower body mass index (BMI) (P=0.020) in the LGE group than in the non-LGE group. (2) The accuracy of CMR in diagnosis of BAV was 96.7% (29/30) compared to the gold standard. In the BAV group, 20 patients (66.7%) were with fusion of left and right cusp (L-R), 5 patients (16.7%) were with fusion of right and noncoronary cusp (R-N), 5 patients (16.7%) were with fusion of left and noncoronary cusp (L-N); patients with BAV had larger left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi), higher proportion of LGE and lower left ventricular ejection fraction (LVEF) than those in non-BAV group (all P<0.05). There were 19 patients with BAV in the LGE group, the cases of L-R, R-N, L-N were 10 (52.6%), 5 (26.3%), and 4 (21.1%), respectively. In the non-LGE group, patients with BAV of L-R, R-N, L-N were 10 (90.9%), 0, and 1 (9.1%), respectively. Patients with LGE had lower body surface area (BSA), LVEF and larger LVEDVi, LVESVi, left ventricular mass index (LVMi) and higher proportion of BAV compared patients without LGE. In addition, the proportion of moderate and severe AI patients was significantly higher in BAV group than in non-BAV group (P=0.009). (3) The consistency of CMR and TTE in evaluating the severity of AI patients: the agreement between TTE and CMR regarding AI severity was satisfactory (kappa value was 0.624, 95%CI 0.402-0.831, P<0.001). (4) The linear regression analysis demonstrated a negative correlation between LVEF and LGE% in BAV and non-BAV group (P<0.001). The multivariate logistic regression analysis showed that the presence of BAV was an independent risk factor of left ventricucar fibrosis (OR=5.050, 95%CI 1.220-20.908, P=0.025) after adjustment for LVEF, hypertension, LVEDVi and LVMi. Conclusion: Multi-parametric CMR provides a satisfactory noninvasive tool for estimation of myocardial fibrosis and ventricular remodeling in patients with AI, and BAV is an independent risk factor for myocardial fibrosis in patients with AI.