Esophageal variceal ligation plus sclerotherapy vs. ligation alone for the treatment of esophageal varices

BACKGROUND

This study aimed to evaluate the efficacy and adverse events of esophageal variceal ligation (EVL) vs. EVL combined with endoscopic injection sclerosis (EIS) in the therapy of esophageal varices.

METHODS

Patients from January 2017 to August 2021 who received EVL alone (control group) or EVL plus EIS (intervention group) were enrolled in this retrospective study. Efficacy, including rebleeding (clinically hematemesis or melena, confirmed by endoscopy as esophagogastric varices bleeding), variceal recurrence rate (the presence of esophagogastric varices which is needed to be treated again) the number of sessions performed to complete eradication of varices, and safety (adverse events) were compared. The variceal recurrence-associated factors were derived by univariate and multivariate logistic regression analyses.

RESULTS

The variceal recurrence and rebleeding rate in the intervention group showed significantly lower than the control group (2.6% vs 10.3%, P = 0.006 and 20.7% vs 37.5%, P = 0.029, P = 0.006, respectively, in the 12-month follow-up). The adverse events (fever, chest pain, swallowing, and esophageal stricture) showed no significant difference between the two groups (P > 0.05). Further research showed that the efficacy of the intervention group was better than the control group only achieved in prophylactically endoscopic treatment patients. The diameter of esophageal varices and gastric varices co-exist showed significant effects on variceal recurrence in intervention group [odds ratio (OR) = 15.856; 95% confidence interval (CI), 1.709-160.143; P = 0.016 and OR = 4.5; 95% CI, 1.42-20.028; P = 0.021; respectively].

CONCLUSIONS

The intervention group may obtain lower recurrence, rebleeding rate, and fewer sessions performed to complete eradication of varices (number of sessions) and similar incidence of adverse events, especially for prophylactically treatment. Among the intervention group, the diameter of esophageal varices and gastric varices were closely associated with variceal recurrence.

Characterization of placental and decidual cell development in early pregnancy loss by single-cell RNA sequencing

Background

Early pregnancy loss (EPL) presents as sporadic or recurrent miscarriage during the first trimester. In addition to chromosomal defects, EPL may result from impairment of the placental-decidual interface at early gestational age due to gene-environmental interactions.

Methods

To better understand the pathogenesis associated with this impairment, cell development in chorionic villi and decidua of different forms of EPL (sporadic or recurrent) was investigated with single-cell RNA sequencing and compared to that of normal first-trimester tissue.

Results

Unique gene expression signatures were obtained for the different forms of EPL and for normal tissue and the composition of placental and decidual cell clusters in each form was established. In particular, the involvement of macrophages in the EPL phenotypes was identified revealing an immunoactive state.

Conclusion

Differential gene expression and unique marker genes among cell clusters from chorionic villi and decidua of miscarried and normal pregnancies, may lead to identification of biomarker for EPL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13578-022-00904-5.

Impact of the critical factors of customer experience on well-being: Joy and customer satisfaction as mediators

This study constructs a formation model of customer well-being (CWB) in customer experience with joy and customer satisfaction as mediating factors linking three critical factors—convenience, performance and relationship of customer experience with CWB. By collecting data from customers of retailing, the model was empirically tested. The results show that the three critical factors all have positive effects on CWB. Meanwhile, service performance has a direct effect on CWB. Joy plays a key role in the formation of CWB mediating the relationship between the three critical factors and CWB. This study is the first in the literature to explore CWB from the perspective of customer experience with joy as an antecedent of CWB. It provides important implications for managers to enhance customer experience and CWB in the service setting. It also helps managers to pay attention to the role of customer joy in customer experience and make full use of it.

[Clinical significance of autoantibodies against ubiquitin carboxyl hydrolase L1 epitopes in the screening and diagnosis of Sjögren syndrome]

Objective: To study the clinical significance of autoantibodies against different ubiquitin carboxyl hydrolase L1 (UCH-L1) epitopes in Sjogren syndrome (SS). Methods: The serum levels of different UCH-L1 epitope autoantibodies in 98 SS patients [SS group, 17 males and 81 females, aged (49.1±12.3) years] in the Fifth Affiliated Hospital of Zhengzhou University and Peking University People's Hospital from January 2017 to January 2020 and 37 healthy controls [control group, 6 males and 31 females, aged (46.3±5.8) years] were determined by enzyme-linked immunosorbent assay (ELISA). Three potential epitopes of UCH-L1 protein were analyzed and synthesized and anti-UCH-L1^203-214 and anti-UCH-L1^58-69 antibodies were studied between the two groups. The levels of the two anti-UCH-L1 antibodies in the two groups were compared. The correlation between the levels of UCH-L1 antibodies and clinical data of SS patients were analyzed by Pearson correlation analysis. Results: The serum levels of anti-UCH-L1^203-214 and anti-UCH-L1^58-69 antibody in SS patients were significantly higher than those in healthy controls (HCs) (anti-UCH-L1^203-214: 108.2±54.3 vs 78.9±25.8, P<0.001, anti-UCH-L1^58-69: 86.8±33.3 vs 60.4±21.5, P<0.001). The positive rates of anti-UCH-L1^203-214 and anti-UCH-L1^58-69 antibodies in serums of SS patients were 27.6 % (27/98) and 25.5% (25/98), and those in HCs were 2.7%(1/37) and 5.4 %(2/37), respectively. In SS patients with positive serum anti-UCH-L1^58-69 antibody, the levels of IgG, γ globulin and rheumatoid factor (RF) and anti-SS-related antigen B (anti-SSB) antibody positive rate were all significantly higher than those in patients with negative antibody (all P<0.05). In SS patients with negative antinuclear antibody (ANA), anti-RNA binding protein (anti-RNP) antibody, anti-SS-related antigen A (anti-SSA) antibody and anti-SSB antibody, the positive rates of anti-UCH-L1^203-214 antibody was 32.1%(9/28), 27.2%(25/92), 36.4%(12/33), 28.6%(18/63), respectively; and the positive rates of anti-UCH-L1^58-69 antibody was 21.4%(6/28), 30.4%(28/92), 30.3%(10/33), 20.6%(13/63), respectively. The level of serum anti-UCH-L1^203-214 antibody in SS patients was positively correlated with the IgA level (r=0.21, P=0.024). The level of anti-UCH-L1^58-69 antibody in SS patients was positively correlated with the levels of γ-globulin, IgG and RF (r=0.35, 0.33, 0.32, all P<0.01). Conclusion: Autoantibodies against UCH-L1 epitopes are correlated with some clinical parameters of SS patients, which is of promising significance in the screening and diagnosis of SS.

P11.75.B Survival benefit of radiotherapy and surgery in patients with lung cancer brain metastases with poor prognosis factors

Background

Radiotherapy and surgery are the standard treatments for lung cancer brain metastases (BMs). However, limitted studies focused on the treatments for patients with lung cancer BMs with poor prognosis factors. The purpose of this study was to investigate the effects of radiotherapy and surgery in patients with lung cancer BMs with poor prognosis factors, providing reference for clinical strategies.

Material and Methods

We analyzed retrospectively 714 patients with lung cancer BMs. A 1:1 propensity score matching (PSM) was performed to balance potential confounders. Analyses of overall survival (OS) and risk factors for OS were assessed by log-rank test and Cox proportional hazard model.

Results

Age ≥65 years, Karnofsky Performance Scale (KPS) score ≤70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type, extracranial metastases, non-surgery and non-radiotherapy led to poor prognosis. Patients were stratified according to these factors. Radiotherapy and surgery showed no survival benefit in patients with aged ≥65 years or pretreatment KPS score ≤70 before and after PSM. Before PSM, whole brain radiotherapy (WBRT) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or extracranial metastases. WBRT also predicted good prognosis in patients with non-surgery. Stereotactic radiosurgery (SRS) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with extracranial metastases or non-surgery. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS and predicted good prognosis in patients with non-radiotherapy. After PSM, SRS improved the OS and predicted good prognosis in patients with non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with non-surgery or extracranial metastases. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS of patients with non-radiotherapy. We defined that the treatment would provide significant survival benefit if it both prolonged the OS and predicted good prognosis. Meanwhile, the results after PSM were more convincing than the results before PSM.

Conclusion

Radiotherapy has significant survival benefit in patients with lung cancer BMs with poor prognosis factors, including patients with ALK/EGFR wild type or extracranial metastases or non-surgery. Surgery only has significant survival benefit in patients with non-radiotherapy.

Topical administration of pterostilbene accelerates burn wound healing in diabetes through activation of the HIF1α signaling pathway

Impaired wound healing is one of a variety of severe diabetic complications and involves many factors, including consistent oxidative stress, prolonged inflammation, impaired angiogenesis, and delayed re-epithelialization. Despite the severe negative impacts that impaired wound healing has on patients' lives, detailed mechanisms and effective therapies are still not fully developed. In this study, we aim to investigate the potential effects and mechanisms of topical administration of pterostilbene and resveratrol on burn wound healing in diabetes. Our in vitro experiments in human umbilical vein endothelial cells showed that long term exposure of hyperglycemia induces oxidative stress and suppression of hypoxia inducible factor1α (HIF1α) signaling pathway, and pterostilbene treatment completely, while resveratrol treatment partly, reversed this effect. Further in vivo experiments in diabetic rats showed that topical administration of pterostilbene exhibited stronger efficacy than resveratrol in normalizing oxidative stress, HIF1α activity, and accelerating burn wound healing in diabetes. We conclude that topical administration of pterostilbene accelerates burn wound healing in diabetes through activation of the HIF1α signaling pathway; thus, pterostilbene may be a potential candidate for clinical treatment of burn wound healing in diabetes.

3d oxidized alginate-porcine liver acellular collagen droplets for tumor microenvironment mimicking

The traditional 2d culture has been proved inferior to reproduce the subtle interaction between cell-to-cell and cell-to-extracellular matrix (ECM) in tumor microenvironment (TME) and collagen in ECM contributes to various malignancies of tumors. Hence, the 3d model contained with collagen may overcome the shortcomings of 2d culture. In this study, the in vitro TME mimicking matrix was prepared by coupling porcine liver-derived collagen (COL) and the dialdehyde group of partially oxidized alginate (OA), namely OA-COL, and the 3d OA-COL droplets were polymerized by divalent calcium ions. In the 3d OA-COL droplets, cancer cells displayed vigorous proliferation, and the cells grew in clusters and formed a unique spindle like clone. Quantitative analysis proved that various gene transcription and protein expression were up-regulated for the cells in the 3d OA-COL droplets, including F-actin reassembling, focal adhesion, pseudopodia formation, and the proteins involved in epithelial-to-mesenchymal transition (EMT). The 3d OA-COL droplets induced the cells with strengthened polarity, invasiveness, higher IC50, and manifested stronger tumorigenicity in vivo. The fabricated 3d OA-COL droplets reproduced a variety of TME parameters, constructed an in vitro model similar to the TME in vivo, and it may facilitate many investigations in cell biology and tumor biology.

Radiological features of Rosai-Dorfman disease: case series and review of the literature

AIM

To improve the accuracy of diagnosis of Rosai-Dorfman disease (RDD) by summarising the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics.

MATERIALS AND METHODS

The clinical manifestations, imaging findings, and pathological characteristics of 14 patients with histopathologically confirmed RDD were analysed retrospectively and a literature review was undertaken.

RESULTS

Of the 14 patients, nine had multiple lesions and five had single lesions. Eight patients had extranodal lesions, while six had mixed-type lesions. In patients with head and neck lesions, plain CT/MRI revealed irregularly shaped, well-defined, homogeneous, and mainly progressive lesions, with marked homogeneous enhancement on multiphasic contrast-enhanced imaging. One patient had dural lesions, one of which iso-intense to grey matter, with patchy hypo-intensity on T2-weighted imaging, meningeal tail signs, and characteristic crabfoot-like enhancement. Three patients with skeletal system involvement exhibited osteolytic bone destruction without sclerosis at the edges, associated soft-tissue masses, or periosteal reactions. Two patients had well-defined subcutaneous lesions, inhomogeneous density, and progressive parenchymal enhancement on contrast-enhanced CT. One patient had multiple intestinal lesions with inhomogeneous nodular thickening of the blind ascending colon and ileum, with marked and progressive enhancement.

CONCLUSION

RDD involvement is mainly multifocal, primarily in the head and neck regions. Plain CT/MRI revealed well-defined, irregularly shaped lesions with homogeneous density/signal, with marked and progressive enhancement on multiphasic contrast-enhanced imaging; however, histopathology is still required to confirm the diagnosis of RDD.

[Efficacy and safety of combination therapy with chemotherapy, programmed death-1 inhibitor and anlotinib in the treatment of advanced dedifferentiated liposarcoma]

Objective: To investigate the efficacy and safety of the combination therapy with chemotherapy, programmed death-1 (PD-1) inhibitor and anlotinib in the treatment of advanced dedifferentiated liposarcoma (DDLPS). Methods: The clinical data of patients with dedifferentiated liposarcoma who received chemotherapy combined with PD-1 inhibitor and anlotinib in the Department of Medical Oncology, Zhongshan Hospital Affiliated to Fudan University from January 1, 2020 to November 30, 2021 were retrospectively analyzed. A total of 24 patients were included in this study, including 12 males and 12 females, with a median age of onset of 56 years (range, 31-69 years). Efficacy and safety in those patients were assessed. Results: All patients had unresectable or metastatic dedifferentiated liposarcoma with G2 (moderate differentiation) or G3 (differential differentiation) in a concise three-grade grading scheme of tumor pathology. Twelve patients received the regimen as the first-line treatment, while the other 7 taken the regimen as second-line treatment and 5 as third-line or above. The median follow-up time for overall survival (OS) was 7.7 months. The overall response rate (ORR) was 20.8% (5/24) and disease control rate (DCR) was 83.3% (20/24) with 5 partial response (PR), 15 stable disease (SD) and 4 progressive disease (PD). Overall, the median progression-free survival (PFS) was 4.9 months (95%CI: 3.4-16.2 months). The ORR of anthracycline-based, eribulin-based or gemcitabine-based regimens was 1/12, 2/6 and 2/6, respectively; and the median PFS was 7.7, 7.3 and 4.4 months, respectively. Waterfall plots showed notable tumor shrinkage of any degree in eribulin and gemcitabine-based regimens(3/6 and 2/6, respectively), while there were more patients presented with SD in anthracycline-based group(9/12). Common adverse reactions included myelosuppression, fatigue, anorexia, rash, pruritus, palpitate, hypothyroidism and hypertension. Conclusions: The combination regimen with chemotherapy, PD-1 inhibitor and anlotinib in the treatment of advanced DDLPS is effective and well tolerable. There are more responders in eribulin or gemcitabine-based regimens.

Perinatal outcomes among twin pregnancies with gestational diabetes mellitus: A nine-year retrospective cohort study

Objective

To compare the outcomes between gestational diabetes mellitus (GDM) vs. non-GDM twin gestations.

Methods

A retrospective cohort study of 2,151 twin pregnancies was performed in a tertiary hospital in Foshan, China, 2012–2020. Pregnancy and neonatal outcomes were compared between women with vs. without GDM using 1:1 propensity score matching (PSM) and multivariable logistic models. For neonatal outcomes, generalized estimating equation (GEE) approach was used to address the intertwin correlation.

Results

Of the 2,151 participants, 472 women (21.9%) were diagnosed with GDM. Women with GDM were older and more likely to be overweight or obese, and more likely have chronic hypertension, assisted pregnancies and dichorionic twins. In the PSM cohort of 942 pregnancies, there was no statistical difference when comparing GDM twin pregnancies and non-GDM in any of the perinatal outcomes, especially in terms of preterm birth (PTB) <37 weeks (P = 0.715), large for gestational age (LGA) (P = 0.521) and neonatal respiratory distress (NRDS) (P = 0.206). In the entire cohort, no significant adjusted ORs for these outcomes were obtained from logistic regression models adjusted for confounders (aOR for PTB < 37 weeks: 1.25, 95% CI: 0.98–1.58; aOR for LGA: 1.26, 95% CI: 0.88–1.82; and aOR for NRDS, 1.05, 95% CI: 0.68–1.64).

Conclusion

Twin pregnancies with GDM and adequate prenatal care have comparable perinatal outcomes to those without.

Association of Optimal Gestational Weight Gain Ranges With Perinatal Outcomes Across Body Mass Index Categories in Twin Pregnancies

IMPORTANCE

The existing gestational weight gain (GWG) recommendations for twin pregnancies are lacking for underweight individuals and are not stratified by obesity class.

OBJECTIVE

To identify optimal GWG ranges associated with reduced adverse perinatal outcomes stratified by prepregnancy body mass index (BMI) categories in twin pregnancies.

DESIGN, SETTING AND PARTICIPANTS

This population-based cohort study of twin pregnancies using data from the National Center for Health Statistics was conducted between January 1, 2014, and December 31, 2018. Statistical analysis was performed from October 24, 2021, to May 7, 2022. The study population comprised 262 604 individuals between 18 and 45 years of age with live-born twins without congenital malformation between 24 and 42 weeks of gestation. Two approaches were used to determine the optimal GWG ranges: a statistics-based approach calculating IQRs of GWG in a low-risk population, and an outcome-based approach identifying GWG thresholds below or above which an adverse perinatal outcome increased.

EXPOSURE

Gestational weight gain.

MAIN OUTCOMES AND MEASURES

Preterm birth less than 36 weeks, gestational hypertensive disorders, small for gestational age status, large for gestational age status, and a composite outcome defined as any occurrence of the individual outcomes.

RESULTS

The main sample comprised 200 810 individuals with twin pregnancies (mean [SD] maternal age, 30.4 [5.5] years; 1624 [0.8%] American Indian or Alaska Native, 13 031 [6.5%] Asian or Pacific Islander, 36 423 [18.1%] Black, and 149 732 [74.6%] White; and 137 409 [68.4%] multiparous). In the low-risk subgroup (n = 61 794), the IQRs of the total GWG after 36 weeks of gestation as assessed using a statistics-based approach and based on BMI group were 15.9 to 22.7 kg for underweight, 15.4 to 22.7 kg for normal weight, 12.7 to 22.2 kg for overweight, 10.0 to 20.0 kg for class 1 obesity, 7.7 to 18.1 kg for class 2 obesity, and 5.9 to 16.3 kg for class 3 obesity. The absolute risk of the composite outcome showed U-shaped associations with GWG across BMI categories. The optimal GWG ranges by 36 weeks identified using an outcome-based approach and BMI group were 17.5 to 24.9 kg for underweight, 15.0 to 24.9 kg for normal weight, 15.0 to 24.9 kg for overweight, 10.0 to 19.9 kg for class 1 obesity, 7.5 to 17.4 kg for class 2 obesity, and 5.0 to 9.9 kg for class 3 obesity. The multivariable logistic models assessed using the validation sample (n = 49 275) showed that GWG defined outside those optimal ranges was associated with preterm birth at less than 36 weeks, gestational hypertensive disorders, and small or large for gestational age.

CONCLUSIONS AND RELEVANCE

This population-based cohort study found that optimal GWG ranges were similar for individuals with underweight and normal weight but decreased with increasing severity of obesity. The current US Institute of Medicine GWG recommendations may be too high for individuals with moderate or severe obesity.

[Safety and efficacy of TIPS combined with iodine-125 seed strands in the treatment of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis]

Objective: To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 (¹²⁵Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods: 25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with ¹²⁵Ⅰseed strand. Tumor thrombus was controlled with ¹²⁵I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t-test, Chi-Squared test or Fisher's exact test. Results: TIPS combined with ¹²⁵Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ² = 4.771, P=0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ² =7.674, P=0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ² =13.246 , P=0.001). Conclusions: TIPS combined with ¹²⁵Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with ¹²⁵Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.

Prenatal dexamethasone exposure induced pancreatic β-cell dysfunction and glucose intolerance of male offspring rats: Role of the epigenetic repression of ACE2

The prevalence of diabetes in children and adolescents has been rising gradually, which is relevant to adverse environment during development, especially prepartum. We aimed to explore the effects of prenatal dexamethasone exposure (PDE) on β-cell function and glucose homeostasis in juvenile offspring rats. Pregnant Wistar rats were subcutaneously administered with dexamethasone [0.1, 0.2, 0.4mg/(kg.d)] from gestational day 9 to 20. PDE impaired glucose tolerance in the male offspring rather than the females. In male offspring, PDE impaired the development and function of β-cells, accompanied with lower H3K9ac, H3K14ac and H3K27ac levels in the promoter region of angiotensin-converting enzyme 2 (ACE2) as well as suppressed ACE2 expression. Meanwhile, PDE increased expression of glucocorticoid receptor (GR) and histone deacetylase 3 (HDAC3) in fetal pancreas. Dexamethasone also inhibited ACE2 expression and insulin production in vitro. Recombinant expression of ACE2 restored insulin production inhibited by dexamethasone. In addition, dexamethasone activated GR and HDAC3, increased protein interaction of GR with HDAC3, and promoted the binding of GR-HDAC3 complex to ACE2 promoter region. Both RU486 and TSA abolished dexamethasone-induced decline of histone acetylation and ACE2 expression. In summary, suppression of ACE2 is involved in PDE induced β-cell dysfunction and glucose intolerance in juvenile male offspring rats.

927 MENDELIAN RANDOMIZATION ANALYSIS SHOWS A CAUSAL EFFECT OF NOISE EXPOSURE ON ALZHEIMER’S DISEASE RISK

Introduction

Epidemiological studies suggested that exposure to transportation noise and long-term community noise was associated with a higher incidence of dementia, especially Alzheimer’s disease (ad). However, since subjects with low education and low income were also more likely to live or work in noisy environments, the association observed between noise exposure and ad may be distorted by education level, income level, and hearing impairment. Thus, whether noise exposure was causally associated with ad risk remained to be further clarified.

Method

A bidirectional Mendelian randomization (BMR) analysis was performed leveraging genome-wide association studies (GWAS) summary statistics of noise exposure (N = 456,380, UK Biobank) and ad (N = 54,162, IGAP) from the OpenGWAS database. Those single nucleotide polymorphisms (SNPs) with a P value less than 1E-05 were selected as instrumental variables (IVs). The TwoSampleMR package (version 0.5.6) was used to do BMR analysis using the inverse variance weighted (IVW) method with default parameters.

Results

The IVW results howed that exposure to noise at different times of day was causally associated with increased risk of ad (daytime: odds ratio [OR] = 2.2113, P = 0.0326; evening: OR = 2.2127, P = 0.0324; nighttime: OR = 2.2110, P = 0.0326; 16-hour: OR = 2.2114, P = 0.0325; 24-hour: OR = 2.2128, P = 0.0324). No obvious pleiotropic effects and heterogeneity were found in the BMR analysis, suggesting good reliability of the causal effect of noise exposure on ad. Moreover, the BMR results remained significant despite removing IVs associated with an education degree, average income, and hearing impairment. There was no reverse causal effect of ad on noise exposure in BMR analysis, which has been deposited in FigShare (https://figshare.com/s/09e30a1a0ccff450246b).

Conclusion

The results BMR analysis demonstrate that noise exposure is causally associated with an elevated risk of ad, independently of education degree, average income, and hearing impairment. Further studies are needed to confirm the underlying mechanism of this effect.

954 FRAILTY PREVALENCE, TRAJECTORIES AND CLINICAL IMPLICATIONS IN PEOPLE WITH COPD: A SYSTEMATIC REVIEW

Background

Frailty is common in people with COPD. This systematic review assesses prevalence and trajectory of frailty and associations with adverse health outcomes in people with COPD.

Method

Three databases searched (Medline, Embase and Web of Science) from 2001 to September 2021, supplemented by forward citation searching and hand-searching reference lists. Eligibility criteria were observational studies of frailty (using any measure) in adults (&gt;18 years) with COPD, any setting (community, outpatient, inpatient, rehabilitation, residential care) assessing frailty prevalence, trajectories, or association with health-related outcomes. Study quality was assessed using Newcastle-Ottawa scale. Screening, quality assessment and data extraction performed independently by two reviewers. We synthesized results using narrative synthesis and, where heterogeneity allowed, random-effects meta-analyses.

Results

We identified 53 eligible studies using 11 frailty measures. Most common were frailty phenotype (32/53), frailty index (5/53) and Kihon checklist (4/53). Prevalence varied between frailty definitions, setting, and age of study population. Using the frailty phenotype, median prevalence was 12.5% in community studies. Prevalence was higher using other measures, and in inpatients, pulmonary rehabilitation and residential care settings. Frailty in COPD is dynamic, with airflow limitation, dyspnoea, and exacerbation frequency associated with worsening. Improvements in frailty status were observed following pulmonary rehabilitation. Frailty was associated with mortality (5/7 studies), COPD exacerbation (7/11), and hospital admission (3/4). Using frailty phenotype, pooled hazard ratio for mortality was 1.80 (95% CI 1.24–2.63) and pooled incident rate ratios were 1.42 (0.94–2.17) for COPD exacerbation and 1.46 (1.10–1.92) for hospitalization. Frailty was cross-sectionally associated with airflow limitation (11/14), dyspnoea (15/16), COPD severity scores (10/12), poorer QOL (3/4) and disability (1/1).

Conclusion

Frailty is a common and dynamic state in COPD, associated with adverse outcomes. However, frailty also appears responsive to intervention. A nuanced understanding of frailty identification, prognosis, and reversibility is required to allow appropriate individualization of COPD care.

AB0012 IDENTIFICATION OF NEW BIOMARKERS FOR SINOMENINE TREATMENT IN RHEUMATOID ARTHRITIS BASED ON BIOINFORMATICS ANALYSIS

Background

Sinomenine (SIN) were extracted from Caulis Sinomenii and achieved an remarkable therapeutic effect for Rheumatoid Arthritis (RA). However, the mechanism of SIN acting on RA is not clear yet.

Objectives

To excavate potential targets and mechanisms of SIN for RA through bioinformatics.

Methods

The microarray data were downloaded from the Gene Expression Omnibus (GEO) database. GEO2R was used to identify differentially expressed genes (DEGs) and the unique value was retained. The potential targets of active compounds from various databases were screened. Based on the overlapping genes, Cytoscape 3.7.2 software was used to construct a protein-protein interactions (PPI) network and to visualize the mechanisms of the treatment by Gene Ontology (GO) enrichment analysis Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis by DAVID database. Finally, we used AutoDockTools 1.5.6 for molecular docking.

Results

A total of 5053 DEGs and 1070 intersections were obtained, including 486 up-regulated and 584 down-regulated targets. 298 SIN targets were collected from various databases, 84 potential targets were obtained by intersecting with DEGs. There are 80 nodes and 305 edges were obtained in PPI network. Based on the degree, the top 10 target genes were AKT1, RGFR, MTOR, JAK2, NOS3, IL2, IL6, MMP9, MAPK8, HSP9OAA1. The core targets was most relevant to protein phosphorylation, signal transduction though GO analysis. The results of the KEGG enrichment analysis included PI3K-Akt signaling pathway and Neuroactive ligand-receptor interaction. Following analysis found that AKT1, EGFR, MTOR and JAK2 existed in the PI3K-Akt signaling pathway. Molecular docking was used to confirm that the binding energy of AKT1 was -7.68 kJ mol -1, EGFR was -5.33kJ mol-1, and MTOR was -4.77 kJ mol-1,JAK2 was -3.25 KJ mol-1. AKT1 and EGFR was further identified as the core targets.

Conclusion

Present study show that AKT1 and EGFR may be the key targets of SIN acting on the PI3K-Akt signaling pathway, thereby inhibiting the progression of disease and improving RA.

Keywords: Sinomenine; Rheumatoid Arthritis; bioinformatics;

Disclosure of Interests

None declared

Funding

This project was supported by grants from National Natural Science Foundation of China (No. 81703783 and 81503415);

Identification of new biomarkers for Sinomenine treatment in Rheumatoid Arthritis based on bioinformatics analysis

XL Shen1, 2L,YQ L1, 2Y,X Guo1, 2,LF Wang1, 2,JK Zhang1, 2,ZT Feng1, 2*

1. Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei 443002, China

2. Medical College of China Three Gorges University, Yichang, Hubei 443002, China

†These authors contributed equally to this work.

*Authors to whom correspondence should be addressed:

Correspondence: Zhitao Feng

E-mail: zhitao.feng@ctgu.edu.cn (Zhitao Feng)

Disclosure of Interests

None declared

POS0978 LUMBAR FACET JOINTS ARTHRITIS RELATES TO ITS ADJACENT MRI INFLAMMATORY LESIONS IN AXIAL SPONDYLOARTHRITIS

Background

Facet joints are frequently impaired in patients with axial spondyloarthritis (axSpA), which raises high disease activity and poor physical function. However, insufficient attention is paid to the relationship between the feature of disease and facet joint arthritis (FJA) in magnetic resonance imaging (MRI) examination, because of lacking an ideal assessment tool. The Canada-Denmark (CANDEN) MRI scoring system is adopted in our study because it is a comprehensive method to assess the alteration of spine [1].

Objectives

We aimed to find relevant factors for lumbar FJA in axSpA patients.

Methods

This was a cross-sectional study that analyzed the lumbar MRI of axSpA patients using the CANDEN system. Demographic and clinical information was recorded. Univariate and multivariate linear mixed model (LMM) was used to screen related factors for lumbar FJA in MRI examinations.

Results

(1) Totally 108 axSpA patients were investigated in our study, while ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) accounted for half respectively. Sixty-five (60.19%) participants were male and their median age was 35 years. (2) Twenty (37.10%) and 1 (1.80%) AS and nr-axSpA suffered lumbar FJA (P<0.05). (3) Univariate LMM found gender, vertebral body corner inflammation subscore (VBCIS), spondylodiscitis subscore (SDS), posterolateral elements inflammation subscore (PLEIS), fat posterior elements subscore (FPES), fat vertebral body subscore (FVBS), and AS disease activity score with C-reactive protein (ASDAS) related to lumbar FJA in AS patients. Besides, gender, the duration of symptom, peripheral arthritis, enthesitis, non-steroidal anti-inflammatory drugs, VCBIS, SDS, PLEIS, FPES, the ankylosis of sacroiliac joints, and bony erosion of hips were involved in the univariate LMM for nr-axSpA. (4) Multivariate LMM displayed that odd ratio (OR) and 95% confidence intervals (CI) of PLEIS, FPES, and ASDAS were 0.66 (0.40, 0.91), 0.45 (0.20, 0.71), and 0.23 (0.01, 0.44) (P<0.05). OR (95%CI) for VBCIS and PLEIS were 0.02 (0.00, 0.04) and 0.23 (0.16, 0.30) in nr-axSpA patients (P<0.05).

Conclusion

Prevalence of lumbar FJA is higher in AS patients than nr-axSpA. This lesion is mainly related to MRI changes of its neighborhood structure, especially inflammatory alterations, rather than demographic and clinical characteristics.

References

[1]Krabbe S, Østergaard M, Pedersen SJ, et al. Canada-Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter-reader reliability in a multiple reader setting. RMD Open. 2019;5(2):e001057.

Disclosure of Interests

None declared

AB0446 IMPROVEMENT OF BELIMUMAB ON QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Accumulating evidence supports an impaired quality of life in patients with systemic lupus erythematosus (SLE). A study reported the patients concerns centred on fatigue[1].

Objectives

We investigated the effect of belimumab on quality of life in patients with SLE.

Methods

SLE patients from Guangdong Second Provincial General Hospital treated with belimumab (n=19) or control group (n=22) were included. Patients in control group were in traditional treatment without belimumab. Data were collected prospectively at treatment initiation and now, including Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Pittsburgh Sleep Quality Index (PSQI) and the SF-36 (Table 1).

Table 1.SLEDAIPPSQIPSF-36PGroupPre-treatmentPost-treatment-Pre-treatmentPost-treatment-Pre-treatmentPost-treatment-Belimumab group11±4.676.11±3.550.0016±3.833.58±2.010.02519.47±187.79685.62±141.780.004Control group8.82±5.693.55±2.110.0006.5±3.525.86±3.240.536541.73±185.22700.42±123.900.002P0.1990.007-0.6650.011-0.7050.723-

Results

Belimumab group showed improvement in SLEDAI, PSQI and the SF-36 (P＜0.05). Control group was improvement in SLEDAI and the SF-36 (P＜0.05), no changes in PSQI (P=0.536). However, the improvement of belimumab group in SLEDAI and PSQI observably outperformed the improvement of control group.

Conclusion

Belimumab effectively improve quality of life in patients with SLE. Further study of pediatric patients with SLE is still warranted.

References

[1]Golder V, Ooi J, Antony A S, et al. Discordance of patient and physician health status concerns in systemic lupus erythematosus. Lupus,2018,27(3):501-506.

Disclosure of Interests

None declared

AB0082 ANTI-INFLAMMATORY EFFECTS OF TOTAL SAPONINS OF PANAX JAPONICUS ON RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is a common autoimmune disease with inflammation[1]. Total saponins of Panax japonicus (TSPJs) are effective components extracted from Panax japonicus[2]. They are known to exhibit anti-inflammatory and immunosuppressoive properties, but their effect of anti-inflammation in collagen-induced arthritis (CIA) remains unclear.

Objectives

To investigate the anti-inflammatory targets of TSPJ predicted by bioinformatics and the verification in CIA mice.

Methods

The targets of RA are obtained in the GeneCards database. we used Cytoscape 3.7.2 software to construct a protein-protein interactions (PPI) network and obtain the hub genes. There are four effective components of TSPJ: Araloside A, chikusetsusaponin IVa, ginsenoside Rg2, and ginsenoside Ro. Through molecular docking between the screened hub genes and the four effective components of TSPJ, the possibility of TSPJ treating CIA mice can be predicted. The collagen II (CII) and complete Freund’s adjuvant (CFA) were used to induce the CIA model. After establishing the model, 32 DBA1/J mice were divided into C group (n=8), M group (n=8), L group(n=8), and H group(n=8). The L and H groups were gavaged with TSPJ at 30 mg/kg or 150 mg/kg, and the C and M groups were gavaged with normal saline. The thickness of the hind paw, number of swollen joints, and arthritis index were evaluated. After 11 days of treatment, all the mice were sacrificed after anesthesia. Sera were collected to centrifuge tubes and the levels of inflammatory factor were determined by the ELISA kit following the instruction.

Results

A gene list that enriches 263 genes was obtained by searching RA from the GeneCards database. The hub genes of the top 3 obtained from Cytoscape 3.7.2 software were tumor necrosis factor (TNF), interleukin-1β (IL-1β), and interleukin-6 (IL-6). In addition, interleukin-17A (IL-17A), a classical inflammatory index in the top 10, was selected and included in the predicted target. The results of molecular docking between the predicted target and the components of TSPJ showed that the combined pose has good stability. The numerical value of hind paw thickness, swollen joint counts, and arthritis index in the intervention groups were lower than those in the M group, suggesting TSPJ played a critical role in improving pathological changes. Compared to those of the C group, the serum levels of TNF-α, IL-1β, IL-6, and IL-17A were increased in the M group. Compared to those of the M group, the levels of TNF-α, IL-1β, IL-6, and IL-17A in the L and H groups were decreased. Compared to those of the L group, the levels of TNF-α, IL-1β, IL-6, and IL-17A in the H group were decreased. The results suggested that TSPJ may decrease the levels of TNF-α, IL-1β, IL-6, and IL-17A in CIA mice. These results suggest that TSPJ may inhibit the inflammatory effects of CIA mice.

Conclusion

Current study demonstrated a novel inhibitory effect of TSPJ on inflammation in CIA mice, and TSPJ can act on the targets predicted by bioinformatics of CIA mice, suggesting the potential of TSPJ as a therapeutic agent for RA and providing new ideas for the clinical treatment of RA.

References

[1]Scherer HU, Haupl T, Burmester GR. The etiology of rheumatoid arthritis. J Autoimmun[J]. 2020;110:102400

[2]Guo X, Ji J, Jose Kumar Sreena GS, et al. Computational Prediction of Antiangiogenesis Synergistic Mechanisms of Total Saponins of Panax japonicus Against Rheumatoid Arthritis. Front Pharmacol[J]. 2020;11:566129

Acknowledgements

Jingkai Zhang: Preparation, data presentation, and specifically writing the initial draft. Xiang Guo: Application of statistical, Verification. Qinpeng Bu and Xiaolan Shen: Conducting a research and investigation process, Provision of study materials. Zhitao Feng: Ideas, Design of methodology, and including mentorship external to the core team.

Disclosure of Interests

None declared

A Splice Site Mutation Associated with Congenital CD59 Deficiency

Congenital CD59 deficiency is a recently described rare autosomal recessive disease associated with CD59 gene mutations that lead to deficient or dysfunctional CD59 protein on the cell surface. The disease is characterized by the early onset of chronic hemolysis, relapsing peripheral demyelinating neuropathy, and recurrent ischemic strokes. To date, there are 14 patients with 4 exon mutations reported globally. A young boy with early onset peripheral neuropathy and atypical hemolytic uremic syndrome is presented. Next-generation sequencing (NGS) identified a homozygous splice site variant in intron 1 of the CD59 gene (c.67 + 1G > T). This variant alters a consensus donor splicing site. Quantitative reverse transcription PCR showed that CD59 mRNA expression in the patient is significantly reduced to 0.017-fold compared to the controls. Flow cytometry showed the lack of CD59 protein on the surface of the patient’s red blood cells. This variant is the first splice site mutation reported to be associated with congenital CD59 deficiency.

Resting heart rate and incident atrial fibrillation: A stratified Mendelian randomization in the AFGen consortium

Background

Both elevated and low resting heart rates are associated with atrial fibrillation (AF), suggesting a U-shaped relationship. However, evidence for a U-shaped causal association between genetically-determined resting heart rate and incident AF is limited. We investigated potential directional changes of the causal association between genetically-determined resting heart rate and incident AF.

Method and results

Seven cohorts of the AFGen consortium contributed data to this meta-analysis. All participants were of European ancestry with known AF status, genotype information, and a heart rate measurement from a baseline electrocardiogram (ECG). Three strata of instrumental variable-free resting heart rate were used to assess possible non-linear associations between genetically-determined resting heart rate and the logarithm of the incident AF hazard rate: <65; 65–75; and >75 beats per minute (bpm). Mendelian randomization analyses using a weighted resting heart rate polygenic risk score were performed for each stratum.

We studied 38,981 individuals (mean age 59±10 years, 54% women) with a mean resting heart rate of 67±11 bpm. During a mean follow-up of 13±5 years, 4,779 (12%) individuals developed AF. A U-shaped association between the resting heart rate and the incident AF-hazard ratio was observed. Genetically-determined resting heart rate was inversely associated with incident AF for instrumental variable-free resting heart rates below 65 bpm (hazard ratio for genetically-determined resting heart rate, 0.96; 95% confidence interval, 0.94–0.99; p = 0.01). Genetically-determined resting heart rate was not associated with incident AF in the other two strata.

Conclusions

For resting heart rates below 65 bpm, our results support an inverse causal association between genetically-determined resting heart rate and incident AF.