[Analysis of outpatient utilization of pneumoconiosis patients in Jiangsu province]

Objective: To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies. Methods: Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed. Results: Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless." Conclusion: The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.

[Analysis of annual hospitalization rate of pneumoconiosis patients and related influencing factors of social security]

Objective: To study the main factors that influencing Pneumoconiosis patients' healthcare seeking behaviors. Methods: Conducting a descriptive analysis to analyze the relationship between the annual hospitalization rate and social security status (medical insurance, location of medical insurance, proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis, whether they receive social assistance and a minimum allowance) , social relationship status of patients (whether there is pneumoconiosis in the family or relatives, whether there is a pneumoconiosis in a friend or a colleague, and whether or not he/she has received financial assistance) , life quality of patients (subjective feelings) and living standard of patients (dietary level) based on data acquired from 120 pneumoconiosis patients. Results: The results of single factor analysis reveal that the location of medical insurance, the proportion of insurance for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis are statistically significant in pneumoconiosis patients' hospital utilization ratio (P<0.05) . The place where medical insurance is located is the current place of residence, the reimbursement ratio of medical insurance for pneumoconiosis is listed as 50%-70%, the work unit has medical insurance, those who have not applied for compensation for pneumoconiosis have a higher utilization rate of hospitalization services. The annual hospitalization rate was 73.3%, 80.0%, 60.6%, 63.0%, respectively. Conclusion: The location of patient medical insurance, the proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, and whether to apply for compensation after pneumoconiosis are the influencing factors of the patients' annual hospitalization rate.

Metabolic syndrome and renal cell cancer risk in Chinese males: a population-based prospective study

Background

Metabolic syndrome (MetS) is now a common public health problem. Few researches have reported the relationship between MetS and the risk of renal cell cancer (RCC). To investigate the association of metabolic syndrome and its components with the risk of RCC in Chinese males, the study was performed in the Kailuan male cohort, a large prospective cohort study.

Methods

A total of 104,333 eligible males enrolled in the every 2-year health checkup were involved in the Kailuan male cohort study (2006-2015). Information on demographic and socioeconomic characteristics, lifestyle, medical history and laboratory tests at baseline entry was obtained. Univariable and multivariable Cox proportional hazards regression models were used to estimate the association between MetS and the RCC risk.

Results

During a median follow-up of 8.9 years, 131 RCC cases were verified over a total of 824,211.96 person-years. Among the 5 single MetS components, hypertension (Systolic/diastolic blood pressure≥130/85 mm Hg or antihypertensive drug treatment of previously hypertension) (HR = 2.35, 95%CI:1.48-3.72) and elevated triglyceride (TG) (≥1.7mmol/L) (HR = 1.78, 95%CI:1.23-2.56) showed significant risk for RCC. Multivariate analysis showed that compared to those who did not meet MetS diagnostic criteria (number of abnormal MetS components&lt;3), HR of RCC risk for participants with MetS was 1.95 (95% CI 1.35-2.83). The number of abnormal MetS components was linearly associated with an increased risk of RCC (P trend&lt;0.001), and the HRs of RCC risk for males with 1, 2 and ≥3 MetS components were 1.27 (0.56-2.90), 2.42 (1.12-5.20) and 3.32 (1.56-7.07), respectively, compared with subjects without MetS components.

Conclusions

MetS was inversely associated with of RCC risk in males.

Key messages

MetS might be one of the scientific and important predictors of RCC. Controlling metabolic syndrome may potentially have key scientific and clinical significance for RCC prevention.

A Traditional Chinese Patent Medicine ZQMT for Neovascular Age- Related Macular Degeneration: A Multicenter Randomized Clinical Trial

BACKGROUND

Anti-VEGF agent ranibizumab has been extensively used as a standard treatment for wet AMD. We investigated whether traditional Chinese medicine could serve as a complementary therapy for this disease.

METHODS

144 patients with neovascular age-related macular degeneration received either intravitreal ranibizumab treatment as needed plus placebo or intravitreal ranibizumab treatment as needed plus an FDA approved traditional Chinese patent medicine named ZQMT. Both groups received treatment for 24 weeks. The primary outcome was the mean change of visual acuity at week 24 as compared to the baseline.

RESULTS

We found that intravitreal ranibizumab treatment plus ZQMT was non-inferior to the treatment with intravitreal ranibizumab alone in improving visual acuity scores at week 24 with patients in both groups who gained substantial numbers of letters. In addition, we found that ZQMT treatment resulted in significant improvements in reducing retinal hemorrhage, fluid, and lesion size. Importantly, administration of ZQMT reduced the number of needed ranibizumab injections (P<0.0001, analysis of variance) in wet AMD patients leading to a significant reduction of drug cost.

CONCLUSION

The combinatory therapy of ranibizumab and traditional Chinese patent medicine ZQMT had equivalent effects on visual acuity improvement and safety profiles as the ranibizumab treatment alone. Ranibizumab injections coupled with ZQMT offer therapeutic advantages in terms of reduction of retinal lesions and ease the financial burden of patients undergoing treatment by reducing the frequency of necessary ranibizumab injections.

P916The effect of a novel, user-friendly, transcatheter edge-to-edge mitral valve repair device in a porcine model of mitral regurgitation

Objective

A new technique has been devised to treat mitral regurgitation (MR) through the transapical route by replicating the edge-to-edge repair surgery. This system encompasses an easy-to-use leaflet clamp and a smaller-sized delivery system (14F–16F). We aimed to evaluate the effectiveness of this device in a porcine model of acute MR.

Methods

Acute MR was induced in 36 anesthetized porcine subjects by severing the major chordae supporting the corresponding segment of the leaflet. This device was then transapically implanted on the prolapsing segment under 3D epicardial echocardiographic guidance. All of the animals were killed 30 days after the procedure to verify the proper location of the implanted devices.

Results

Cutting the major chordae induced an eccentric MR jet (MR grade: 3+, 27.8%/4+, 72.2%) in all of the animals. Every single pig was then successfully implanted with one clamp. The duration of catheterization ranged from 18 to 40 minutes. Overt MR reduction was observed following the procedure through echocardiography; residual MR was mild in 8 cases, trivial in 19 cases, and absent in 9 cases. In terms of hemodynamic parameters, the mean and maximum mitral valve pressure gradients were increased significantly (p<0.01), but these values were less than 4 mmHg in all of the cases. Autopsy demonstrated that all but one device were precisely placed to clip the prolapsing segment of the mitral valve, and there was no evidence of thrombosis, thromboembolism or impairment of the cardiac structure.

Table 1. Changes in hemodynamic parameters, cardiac size, and functional parameters after the procedure Preoperation Postoperation P value MR-maxA (mm2) 7.27±2.13 1.54±1.29 0.000 MVPG-max (mmHg) 1.95±0.47 3.66±0.62 0.000 MVPG-mean (mmHg) 0.87±0.31 1.7±0.28 0.000 LVEDD (mm) 46.08±2.85 46.44±3.53 0.239 LVESD (mm) 29.11±3.44 29.08±3.62 0.940 LVEF (%) 66.53±6.4 67.14±4.93 0.256 LAD (mm) 35.75±2.24 36.42±1.99 0.057 LAA (mm2) 12.95±2.22 12.64±1.55 0.301

Figure 1

Conclusions

Transapical implantation of the novel mitral valve repair device is effective and safe in reducing acutely induced MR in pigs; thus, suggesting that it has great potential for clinical benefit in patients with MR.

Acknowledgement/Funding

Shanghai Science and Technology Committee

Cerebral venous circulation changes caused by aneurysmal subarachnoid hemorrhage

BACKGROUND

The aneurysmal subarachnoid hemorrhage (aSAH) is an acute severe hemorrhagic stroke with high morbidity and mortality with poor prognosis.

OBJECTIVE

This study aims to analyze the changes of cerebral venous circulation in patients with aneurysmal subarachnoid hemorrhage by digital subtraction angiography (DSA).

MATERIALS AND METHODS

Totally, 57 patients with aSAH, 48 patients with unruptured aneurysms, and 45 patients without aneurysms (control group) were enrolled. The microvascular cerebral circulation time (mCCT), venous cerebral circulation time (vCCT), cerebral arterioles and cortical veins were analyzed by DSA.

RESULTS

There were changes of cerebral microvessels and cortical veins in patients with aSAH. The mCCT (6.15±1.37 s) and vCCT (2.79±0.34 s) of aSAH patients significantly increased compared with control patients (3.74±0.50 s; 2.64±0.32 s) (P < 0.05). However, the mCCT increased more compared with vCCT in aSAH patients (P < 0.001), while the vCCT increased more compared with mCCT in severe aSAH cases (P < 0.01). There was no significant difference in mCCT and vCCT between patients with unruptured aneurysms and controls (P = 0.131; P = 0.621).

CONCLUSIONS

The mCCT increases in acute aSAH patients within 72 hours and vCCT increases in severe aSAH cases.

Decrease of FGF19 contributes to the increase of fasting glucose in human in an insulin-independent manner

PURPOSE

The ileum-derived fibroblast growth factor 19 (FGF19) plays key roles in hepatic glucose homeostasis in animals in an insulin-independent manner. Here, we analyzed the association of FGF19 with glucose effectiveness (GE, the insulin-independent glucose regulation), as well as hepatic glucose production (HGP) in Chinese subjects.

METHODS

GE was measured by frequently sampled intravenous glucose tolerance test (FSIVGTT) in normal glucose tolerance (NGT), isolated-impaired glucose tolerance (I-IGT), and isolated-impaired fasting glucose (I-IFG) subjects. The oral glucose tolerance test-derived surrogate of GE (oGE) was determined in NGT, I-IFG, combined glucose intolerance (CGI), and type 2 diabetes (T2DM) subjects. HGP was assessed by labeled ([3-³H]-glucose) hyperinsulinemic-euglycemic clamp in NGT subjects. Insulin secretion and sensitivity were calculated by the hyperglycemic and hyperinsulinemic-euglycemic clamps in a subgroup of NGT, I-IGT, and I-IFG subjects. Serum FGF19 levels were determined by ELISA.

RESULTS

FGF19 positively correlated with GE (r = 0.29, P = 0.004) as determined by FSIVGTT. The result was further confirmed by oGE (r = 0.261, P < 0.001). FGF19 was negatively associated with FPG (r = - 0.228, P = 0.025), but the association no longer existed after adjusting for GE (r = - 0.177, P = 0.086). FGF19 was negatively associated with basal HGP (r = - 0.697, P = 0.006). However, the correlation between FGF19 and insulin secretion and sensitivity were not found.

CONCLUSIONS

FGF19 levels are associated positively with GE and negatively with HGP. The increase of FPG in human is at least partially due to the decrease of FGF19 in an insulin-independent manner.

Decreased Expression of TIM-3 on Th17 Cells Associated with Ophthalmopathy in Patients with Graves' Disease

Purpose:

Thyroid-associated Ophthalmopathy (TAO) is one of the most common orbital immunological diseases in adults. CD4+ helper T (Th) cells play important roles in the pathogenesis of TAO. But the mechanisms regulating CD4+ T cell activity is unclear. This study examines T cell immunoglobulin domain and mucin domain 3 (TIM-3) expression in helper T cell type 1 (Th1), Th17, and regulatory T cells in sufferers of TAO.

Methods:

Participants were divided into 3 groups: patients with TAO, patients with Graves’ disease but without orbitopathy (GD), and healthy control patients (HC). Peripheral blood samples were collected for each patient in the designated group. Flow cytometry methods assessed the frequency of Th1 (CD4+IFN-γ+), Th17 (CD4+IL-17+), regulatory T cells (CD4+CD25hiCD127lo), and TIM-3 protein expression. Mean fluorescence intensity (MFI) measured the magnitude of TIM-3 expression and the percentage of TIM-3+ cells for each patient.

Results:

Compared to the GD group, TAO patients possessed higher frequencies of Th1 and Th17 cells in peripheral blood samples. The percentage of TIM-3+ Th1 and Th17 cells was significantly lower in the TAO patients than the GD group. Across all patients sampled, TIM-3+ cell percentage negatively correlated with Th1 cell frequency. Th1 and Th17 cells exhibited significantly decreased expression of TIM-3 in TAO patients compared to healthy controls. Regulatory T cells showed little TIM-3 expression and we observed no significant differences in frequency between groups.

Conclusion:

These results suggest a role for TIM-3 in the regulation of Th1 and Th17 cells and the pathogenesis of Graves’ ophthalmopathy.

[Situation analysis of timing of first visit of anti-mitochondrial antibody-positive patients]

Objective: To understand the basic information of anti-mitochondrial antibody (anti-AMA)-positive patients after initial diagnosis, and to set groundwork for further exploring the clinical significance of AMA in various diseases. Methods: Demographic data and related clinical information recorded through the Information System of Peking University People's Hospital from January 2013 to December 2016 were collected. Patients whose AMA and/or AMA-M2 first- tested as positive were recorded. Complications were classified according to the International Classification of Diseases. Results: A total of 1323 AMA positive cases were discovered for the first time. Among them, 78.0% were women, and the age of initial diagnosis was 56.8 ± 16.0 years. The first three initially diagnosed departments were rheumatology and immunology (37.4%), liver Disease (15.9%) and hematology (15.9%) relevant to musculoskeletal and connective tissue diseases (45.2%), hematology and hematopoietic organs and immune diseases (30.6%) and circulatory system diseases (29.7%). There were 297 newly confirmed cases of primary biliary cholangitis (PBC); accounting for 89.2% of women, and the age of initial diagnosis was 60.1 ± 12.4 years. The top three departments of initially diagnosed as PBC were liver disease (37.7%), rheumatology (33.0%) and gastroenterology (15.2%), of which 39.7% had musculoskeletal and connective tissue diseases, 27.9% had circulatory diseases, and 24.9 % were combined with endocrine and metabolic diseases. Conclusion: Besides PBC and other autoimmune diseases, AMA and / or AMA-M2 positivity can be observed in a variety of diseases in several clinical departments, and its clinical significance remains to be further clarified.

Latrophilin mediates insecticides susceptibility and fecundity through two carboxylesterases, esterase4 and esterase6, in Tribolium castaneum

Latrophilin (LPH) is known as an adhesion G-protein-coupled receptor which involved in multiple physiological processes in organisms. Previous studies showed that lph not only involved the susceptibility to anticholinesterase insecticides but also affected fecundity in Tribolium castaneum. However, its regulatory mechanisms in these biological processes are still not clear. Here, we identified two potential downstream carboxylesterase (cce) genes of Tclph, esterase4 and esterase6, and further characterized their interactions with Tclph. After treatment of T. castaneum larvae with carbofuran or dichlorvos insecticides, the transcript levels of Tcest4 and Tcest6 were significantly induced from 12 to 72 h. RNAi against Tcest4 or Tcest6 led to the higher mortality compared with the controls after the insecticides treatment, suggesting that these two genes play a vital role in detoxification of insecticides in T. castaneum. Furthermore, with insecticides exposure to Tclph knockdown beetles, the expression of Tcest4 was upregulated but Tcest6 was downregulated, indicating that beetles existed a compensatory response against the insecticides. Additionally, RNAi of Tcest6 resulted in 43% reductions in female egg laying and completely inhibited egg hatching, which showed the similar phenotype as that of Tclph knockdown. These results indicated that Tclph affected fecundity by positively regulating Tcest6 expression. Our findings will provide a new insight into the molecular mechanisms of Tclph involved in physiological functions in T. castaneum.

[Effect of primary cilia on growth plate chondrocyte proliferation of young rats with chronic renal insufficiency]

Objective: To observe the effect of primary cilia on growth plate chondrocyte proliferation of young rats with chronic renal insufficiency (CRI). Methods: Male 2-week-old Sprague-Dawley rats were randomly divided into two groups (with 10 in each group): Sham group (only left ureter was exposed) and CRI group (left ureter was ligated). Rats were sacrificed 2 weeks after operation and the total length of tibia was measured. Histological sections of tibia were taken to observe the chondrocytes of growth plate proliferative region and the expression rate of primary cilia. Chondrocytes from growth plate in two groups were isolated and cultured in vitro to P3 generation and the chondrocyte proliferation rate at 24 h were detected. The primary cilia expression rate and cilia length of chondrocytes were measured. Western blot was used to detect the expression of intraflagellar transport 88 (IFT88) protein and the gray scale was analyzed. Results: The total length of tibia was shorter in CRI group [(35.84±4.56) mm vs (42.33±3.44) mm, P=0.002]. The results of tibial histological section showed that chondrocytes of growth plate proliferative region were unorganized and the number of chondrocyte with columnar structure was less in CRI group (2.71±1.10 vs 7.68±1.32, P<0.001). The primary cilia expression rate of chondrocytes was higher in CRI group [(35.53±7.41)% vs (18.31±5.12)%, P<0.001]. The chondrocyte proliferation rate at 24 h was lower in CRI group [(11.38±6.10)% vs (24.35±8.46)%, P=0.001]. The primary cilia expression rate of chondrocytes was higher in CRI group [(60.12±7.86)% vs (32.17±8.97)%, P<0.001], and the primary cilia length of chondrocytes was longer in CRI group [(3.54±1.61) μm vs (1.96±0.82) μm, P=0.012]. The protein IFT88 was more highly expressed in CRI group (0.47±0.23 vs 0.17±0.10, P=0.001). Conclusion: The primary cilia expression rate of growth plate chondrocytes was higher in the rats with CRI, resulting in decreased chondrocyte proliferation rate and growth retardation of tibial growth plate.

Proton migration in hydrocarbons induced by slow highly charged ion impact

Different from most of the previous studies using light or photons, we use highly charged ions as projectiles to activate proton migration in the smallest saturated and unsaturated hydrocarbon molecules, i.e., CH₄ and C₂H₂. The H₃ ⁺ formation channel (H₃ ⁺ + CH⁺) and isomerization channel (C⁺ + CH₂ ⁺), serving as indicators of proton migration, are observed in the fragmentation of CH₄ and C₂H₂ dications. Corresponding kinematical information, i.e., kinetic energy release, is for the first time obtained in the collisions with highly charged ions. In particular, for the C⁺ + CH₂ ⁺ channel, a new pathway is identified, which is tentatively attributed to the isomerization on high-lying states of acetylene dication. The kinetic energy release spectra for other two-body breakup channels are also determined and precursor dication states could thus be identified.

PAI-1 and Maspin gene evolution analysis in plateau zokor (Myospalax baileyi)

Hypoxia is one of the most obvious environmental characteristics of the Qinghai-Tibet Plateau. Increasing tissue microvessel density is an important mechanism for plateau animals to adapt to the hypoxic environment.

Combination of LINE-1 hypomethylation and RASSF1A promoter hypermethylation in serum DNA is a non-invasion prognostic biomarker for early recurrence of hepatocellular carcinoma after curative resection

Hepatocarcinogenesis, a multistep process, involves not only genetic mutations but also epigenetic alterations. Widespread of global DNA hypomethylation is accompanied with specific regional hypermethylation especially at tumor suppressor genes' promoters. The aim of this study is to determine the efficacy of combined DNA methylation analysis of a global DNA methylation marker - LINE-1 and a tumor suppressor gene highly associated with the malignancy of HCC- RASSF1A in serum as a novel prognostic marker for diagnosis of early recurrence after curative resection.LINE-1 was hypomethylated in 66.7% (70/105) and RASSF1A promoter was hypermethylated in 73.3% (77/105) of HCC serum DNA samples by methylation specific PCR, but in none of the healthy controls: LINE-1 hypometylation (0/50) and RASSF1A hypermethylation (0/50). A significant association was found between LINE-1 hypomethylation and clinical pathologic features including HBsAg positivity (p=0.009), tumor size (p=0.001) and AFP levels (p<0.001). Besides, significant correlation was detected between RASSF1A promoter hypermethylation and lymph nodes metastasis (p=0.045).The results of Kaplan-Meier estimates of survival suggested that LINE-1 hypomethylation was highly associated with poor survival of patients (disease-free survival p=0.002, overall survival p=0.0123). More importantly, co-evaluation of LINE-1 hypomethylation and RASSF1A promoter hypermethylation was found to be significantly correlated to early recurrence and poor prognosis (disease-free survival p=0.0001, overall survival p=0.05) in patients after curative resection.In conclusion, our study showed that the combined examination of LINE-1 hypomethylation and RASSF1A promoter hypermethylation was effective in predicting early recurrence of HCC after curative resection. Patients with dual positivity of LINE-1 hypomethylation and RASSF1A promoter hypermethylation should be supplied with more intensive care and close follow-up after they undergo tumor resection.