Degradation behaviors of Nabumetone and its metabolite during UV/monochloramine process: Experimental and theoretical study

This study investigated degradation behaviors of a nonsteroidal anti-inflammatory drug Nabumetone (NMT) and its major metabolite 6-methoxy-2-naphthylacetic acid (MNA) in the coupling process of ultraviolet and monochloramine (UV/NH2Cl). The second-order rate constants of the contaminants reacting with reactive radicals (HO•, Cl•, Cl2•⁻, and CO3•⁻) were determined by laser flash photolysis experiments. HO• and Cl• contributed predominantly with 52.3% and 21.7% for NMT degradation and 60.8% and 22.3% for MNA degradation. The presence of chlorides retarded the degradation of NMT, while promoted the destruction of MNA, which was ascribed to the photosensitization effects of MNA under UV irradiation. Density functional theory (DFT) calculations revealed that radical adduct formation (RAF) was dominant pathway for both HO• and Cl• reacting with the contaminants, and hydrogen atom transfer (HAT) preferred to occur on side chains of NMT and MNA. NMT reacted with NO2• through single electron transfer (SET) with the second-order rate constant calculated to be 5.35 × 107 (mol/L)-1 sec-1, and the contribution of NO2• was predicted to be 13.0% of the total rate constant of NMT in pure water, which indicated that NO2• played a non-negligible role in the degradation of NMT. The acute toxicity and developmental toxicity of NMT were enhanced after UV/NH2Cl treatment, while those of MNA were alleviated. The transformation products of both NMT and MNA exhibited higher mutagenicity than their parent compounds. This study provides a deep understanding of the mechanism of radical degradation of NMT and MNA in the treatment of UV/NH2Cl.

Heavy metals in centralized drinking water sources of the Yangtze River: A comprehensive study from a basin-wide perspective

Water quality in the Yangtze River Basin (YRB) has received considerable attention because it supplies water to 400 million people. However, the trends, sources, and risks associated with heavy metals (HMs) in water of centralized drinking water sources (CDWSs) in the YRB region are not well understood due to the lack of high-frequency, large-scale monitoring data. Moreover, research on the factors affecting the transportation of HMs in natural water are limited, all of which significantly reduce the effectiveness of CDWSs management. Therefore, this study utilized data on 11 HMs and water quality from 114 CDWSs, covering 71 prefecture-level cities (PLC) in 15 provinces (cities), to map unprecedented geospatial distribution of HMs in the YRB region and examine their concentrations in relation to water chemistry parameters. The findings revealed that the frequency of detection (FOD) of 11 HMs ranged from 28.59% (Hg) to 99.64% (Ba). The mean concentrations are ranked as follows: Ba (40.775 μg/L) > B (21.866 μg/L) > Zn (5.133 μg/L) > V (2.668 μg/L) > Cu (2.049 μg/L) > As (1.989 μg/L) > Mo (1.505 μg/L) > Ni (1.108 μg/L) > Sb (0.613 μg/L) > Pb (0.553 μg/L) > Hg (0.002 μg/L). Concentrations of Zn, As, Hg, Pb, Mo, Sb, Ni, and Ba exhibited decreasing trends from 2018 to 2022. Human activities, including industrial and agricultural production, have led to higher pollution levels in the midstream and downstream of the river than in its upstream. Additionally, the high concentrations of Ba and B are influenced by natural geological factors. Anion concentrations and nutrient levels, play a significant role in the transport of HMs in water. Probabilistic health risk assessment indicates that As, Ba, and Sb pose a potential carcinogenic risk. Additionally, non-carcinogenic risk to children under extreme conditions should also be considered.

Separation of carbohydrates using dynamically adsorbed borate stationary phase for hydrophilic interaction liquid chromatography

In this work, a chromatographic method for the separation of carbohydrates was proposed. Tris-(hydroxymethyl)-amine (TRIS) functionalized silica-based hydrophilic interaction liquid chromatography (HILIC) stationary was synthesized. The dynamically absorbed borate layer is generated by using borate buffer as a polar modifier due to the complexation of borate with TRIS ligand in the stationary phase. The chromatographic systems were analyzed by the linear solvation energy relationship model. The calculated system constants revealed the enhancement of anionic exchange by the addition of borate in the mobile phase system. In addition, ligand exchange is critical for the retention and elution order of sugars and sugar alcohols. Carbohydrates displayed prolonged retention with different selectivity profiles relating to their complexation coefficients with borate. Experiment results showed that the effect of borate in this chromatographic system was stable within the range of pH 3-7 and borate concentration of 5-15 mM. This work provides a complementary solution for the separation of carbohydrates. It can also be extended to the separation of glycosides.

Small extracellular vesicles facilitate epithelial-mesenchymal transition in chronic rhinosinusitis with nasal polyps via the miR-375-3p/QKI axis

BACKGROUND

Epithelial-mesenchymal transition (EMT) plays a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, the involvement of small extracellular vesicles (sEVs) in EMT and their contributions to CRSwNP has not been extensively investigated.

METHODS

SEVs were isolated from nasal mucosa through ultracentrifugation. MicroRNA sequencing and reverse-transcription quantitative polymerase chain reaction were employed to analyze the differential expression of microRNAs carried by sEVs. Human nasal epithelial cells (hNECs) were used to assess the EMT-inducing effect of sEVs/microRNAs. EMT-associated markers were detected by western blotting and immunofluorescence. Dual-luciferase reporter assay was performed to determine the target gene of miR-375-3p. MicroRNA mimic, lentiviral, and plasmid transduction were used for functional experiments.

RESULTS

In line with the greater EMT status in eosinophilic CRSwNP (ENP), sEVs derived from ENP (ENP-sEVs) could induce EMT in hNECs. MiR-375-3p was elevated in ENP-sEVs compared to that in control and nonENP. MiR-375- 3p carried by ENP-sEVs facilitated EMT by directly targeting KH domain containing RNA binding (QKI) at seed sequences of 913-919, 1025-1033, and 2438-2444 in 3'-untranslated region. Inhibition of QKI by miR-375-3p overexpression promoted EMT, which could be reversed by restoration of QKI. Furthermore, the abundance of miR-375-3p in sEVs was closely correlated with the clinical symptom score and disease severity.

CONCLUSIONS

MiR-375-3p-enriched sEVs facilitated EMT by suppressing QKI in hNECs. The association of miR-375-3p with disease severity underscores its potential as both a diagnostic marker and a therapeutic target for the innovative management of CRSwNP.

Synthesis and evaluation of aromatic stationary phases based on linear solvation energy relationship model for expanded application in supercritical fluid chromatography

In the last decade, the separation application based on aromatic stationary phases has been demonstrated in supercritical fluid chromatography (SFC). In this paper, four aromatic stationary phases involving aniline (S-aniline), 1-aminonaphthalene (S-1-ami-naph), 1-aminoanthracene (S-1-ami-anth) and 1-aminopyrene (S-1-ami-py) were synthesized based on full porous particles (FPP) silica, which were not end-capped for providing extra electrostatic interaction. Retention mechanism of these phases in SFC was investigated using a linear solvation energy relationship (LSER) model. The aromatic stationary phases with five positive parameters (a, b, s, e and d+) can provide hydrogen bonding, π-π, dipole-dipole and cation exchange interactions, which belong to the moderate polar phases. The LSER results obtained using routine test solutes demonstrated that the aforementioned interactions of four aromatic stationary phases were influenced by the type and bonding density of the ligand, but to a certain extent. Furthermore, the LSER data verified that the S-1-ami-anth column based on full porous particles silica had higher cation exchange capacity (d+ value), compared to the commercialized 1-AA column (based on the ethylene-bridged hybrid particles). The relationship between the d+ value and SFC additive was quantitatively proved so as to regulate electrostatic interaction reasonably. This value was greatly increased by phosphoric acid, slightly increased by trifluoroacetic acid and formic acid, but significantly reduced by ammonium formate and diethylamine. Taking the S-1-ami-naph column as an example, better peek shape of the flavonoids was obtained after the addition of 0.1 % phosphoric acid in MeOH while isoquinoline alkaloids were eluted successfully within 11 min after adding 0.1 % diethylamine in MeOH. Combined with the unique π-π interaction and controllable electrostatic interaction, the aromatic stationary phases in this study have been proven to have expandable application potential in SFC separation.

A simple fluorescence pyrocatechol-polyethyleneimine detection method for 3-MCPD

A rapid fluorescence detection method was established for 3-monochloropropane-1,2-diol (3-MCPD). The detection system works based on the fluorescence quenching of pyrocatechol-polyethyleneimine (PCh-PEI) polymer by 3-MCPD. The fluorescence quenching ability of 3-MCPD for PCh-PEI polymer was measured at different pH and temperatures. Indeed, in the presence of 3-MCPD, the fluorescence intensity of PCh-PEI polymer solution was quenched best at 100 °C and pH 8.5. Also, the effect of different concentrations of 3-MCPD on the optical properties of the PCh-PEI polymer was examined. Under optimal experimental conditions, fluorescence detection was linear in a range of 0.08-2.0 mg per L 3-MCPD, with a calculated detection limit of 0.06 mg L-1 and a correlation coefficient of 0.9974. Concisely, the reported method has good sensitivity and can be used for the rapid detection of 3-MCPD contamination in food products.

Anti-BPH lignans from Urtica triangularis subsp. pinnatifida (Hand.-Mazz.) C.J.Chen

A new lignan named (-)-ginkgool-9-O-β-glucopyranoside (1) together with eight known lignans (2-9) were isolated from Urtica triangularis subsp. pinnatifida (Hand.-Mazz.) C.J.Chen. According to the mass spectrometry and spectroscopic analyses, the gross structure and absolute configuration of the new lignan were elucidated. The cytotoxic effects of compounds 1-9 on BPH-1 cells and the docking results on type II 5α-reductase were analysed to evaluate their anti-BPH activity. The results showed better anti-BPH activity that compound 4 displaying an IC50 of 79.75 ± 3.68 μM than finasteride presenting an IC50 of 91.8 ± 3.74 μM. Compounds 1, 2 and 5 had moderate anti-BPH activity compared with finasteride.

Supercritical fluid-based method for selective extraction and analysis of indole alkaloids from Uncaria rhynchophylla

The development of an approach based on simultaneous supercritical fluid extraction-sample cleanup, followed by supercritical fluid chromatography/tandem mass spectrometry (SFE-SFC-MS/MS) was as a tool for the extraction, separation and characterization of indole alkaloids of Uncaria rhynchophylla. A two-step SFE method was designed. A mixture of the U. rhynchophylla sample and an adsorbent named C18SCX with the ratio of 1:1 (w/w) was placed into an extraction cell. The extraction temperature was 40 °C and the pressure was 25 Mpa. In the first step, 10 % EtOH as the co-solvent was used to extract for 60 min, which was considered as a cleanup process to remove non-alkaloid components. In the second step, 0.1 % DEA was added to 10 % EtOH and it extracted for 60 min to obtain the desired extract. By introducing an additional adsorbent, the specificity of SFE towards alkaloids was greatly improved. An SFC-MS/MS method was then utilized for analysis of the SFE extract. Using 2-EP as stationary phase with the gradient elution of 0-10 min, 5-25 % EtOH (+0.05 % DEA) in CO2, column temperature 40 °C, and back pressure 13.8 Mpa, 10 peaks were separated within 8 min. Further MS/MS analysis confirmed that nine of the 10 peaks in the SFE extract were indole alkaloids. This study developed a supercritical fluid-based method specifically towards extraction and analysis of alkaloids, which is helpful to the study of alkaline compounds in complex samples.

[Risk factors analysis of protein energy wasting in children with chronic kidney disease]

Objective: To analyze the clinical characteristics and risk factors of protein energy wasting (PEW) in children with chronic kidney disease (CKD). Methods: Clinical data of 231 children with chronic kidney disease hospitalized in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to January 2023 were retrospectively analyzed to explore the incidence of PEW. According to the diagnostic criteria of CKDPEW, they were divided into a CKDPEW group and a non PEW group. The comparison between the groups was performed by independent-sample t test and Chi-squared test, and the risk factors were analyzed by multivariate Logistic regression. Results: Among the 231 children, there were 138 males and 93 females, with a visiting age of 9.9 (7.9, 16.0) years; 6 cases were in stage 1, 14 cases in stage 2, 51 cases in stage 3, 36 cases in stage 4, and 124 cases in stage 5. A total of 30 children (13.0%) with CKD PEW were diagnosed at the age of 7. 1 (3.8, 13.2) years, including 1 case in stage 1, 1 case in stage 2, 5 cases in stage 3, 5 cases in stage 4, and 18 cases in stage 5. There were a total of 201 cases (87.0%) in the non PEW group, diagnosed at the age of 11.8 (8.5, 12.2) years, including 5 cases in stage 1, 13 cases in stage 2, 46 cases in stage 3, 31 cases in stage 4, and 106 cases in stage 5. The Chi-squared test and t test showed that the systolic blood pressure, diastolic blood pressure, birth weight and carbon dioxide binding capacity of the CKD PEW group were lower than those of the non PEW group ((109±22) vs. (120±20) mmHg (1 mmHg=0.133 kPa), (72±19) vs. (79±16) mmHg, (2.9±0.5) vs. (3.2±0.6) kg, (17±4) vs. (19±4) mmol/L,t=2.85, 2.14, 0.67, 2.63, all P<0.05). Multivariate logistic regression analysis showed that carbon dioxide binding capacity and birth weight were independent protective factors of CKDPEW in children (OR=0.81 and 0.36, 95%CI=0.73-0.90 and 0.17-0.77, respectively; both P<0.01); the risk of PEW in CKD children decreased by 0.187 times for every 1 mmol/L increment in carbon dioxide binding capacity, and 0.638 times for every 1 kg increment in birth weight. Conclusions: The incidence of protein energy expenditure in children with chronic kidney disease is lower than that in the previous researches. PEW can appear in CKD 1-2 stage, and attention should be paid to it in the early stage of CKD in clinical practice. Low birth weight CKD children are susceptible to PEW, and actively correcting metabolic acidosis can reduce the risk of CKDPEW.

Supercritical fluid chromatography based on reversed-phase/ ion chromatography mixed-mode stationary phase for separation of spirooxindole alkaloids

The present paper illustrates the versatility of the supercritical fluid chromatography (SFC) since, for the first time, four spirooxindole alkaloids (SOAs) including two pairs of isomers were separated by using two types of reversed-phase/ ion chromatography (RP/IC) mixed-mode stationary phases. Two mixed-mode stationary phases (C8SAX and C8SCX) was simultaneously provided dispersive and electrostatic interactions, which were suitable for the separation of such alkaloids. This study tried to provide an in-depth understanding of the SFC separation mechanism of the mixed-mode stationary phase through investigation of the impact of changes in mobile phase composition on alkaloids' retention behavior. On C8SAX, due to the strong electrostatic repulsion, there was a very narrow elution window of the alkaloids, of which behaviors were hardly affected by adding diethylamine in mobile phase. When adding formic acid or acidic ammonium formate, the prolonged retention time of alkaloids was presented because of the shielded effect of formate anions on the electrostatic repulsion. In particular, better peak shape and improved resolution were obtained by using acidic ammonium formate due to the deactivation of silanol groups by ammonium cations. On the other hand, both formic acid and acidic ammonium formate can strengthen the electrostatic attraction of C8SCX, causing difficult elution of the alkaloids. Ammonium cations from either the protonated diethylamine or the ionized ammonium formate, were considered as counter ions to effectively mask the electrostatic attraction of C8SCX, to significantly reduce the retention of alkaloids, but improve the resolution. Finally, utilizing two developed SFC methods, i.e., C8SAX with EtOH+ 10 mM acidic ammonium formate in CO2, or C8SCX with EtOH+0.1% diethylamine in CO2, the baseline separation of corynoxeine and isocorynoxeine, rhynchophylline and isorhynchophylline was achieved within 5 min.

Impact of delay extubation on the reintubation rate in patients after cervical spine surgery: a retrospective cohort study

BACKGROUND

The incidence of cervical airway obstruction after cervical spine surgery (CSS) ranges from 1.2 to 14%, and some require reintubation. If not addressed promptly, the consequences can be fatal. This study investigated delayed extubation's effect on patients' reintubation rate after cervical spine surgery.

METHODS

We performed a retrospective case-control analysis of cervical spine surgery from our ICU from January 2021 to October 2022. Demographic and preoperative characteristics, intraoperative data, and postoperative clinical outcomes were collected for all 94 patients. Univariable analysis and multivariable logistic regression were used to analyze postoperative unsuccessful extubation risk factors following cervical spine surgery.

RESULTS

The patients in the early extubation (n = 73) and delayed extubation (n = 21) groups had similar demographic characteristics. No significant differences were found in the reintubation rate (0 vs. 6.8%, p = 0.584). However, the delayed extubation group had significantly more patients with 4 and more cervical fusion segments (42.9 vs. 15.1%, p = 0.013),more patients with an operative time greater than 4 h (33.3 vs. 6.8%, p = 0.004)and all patients involved C2-4 (78 vs. 100%, p = 0.019).Also, patients in the delayed extubation group had a longer duration of ICU stay (152.9 ± 197.1 h vs. 27.2 ± 45.4 h, p < 0.001) and longer duration of hospital stay (15.2 ± 6.9 days vs. 11.6 ± 4.1 days, p = 0.003). Univariate and multivariate analysis identified the presences of cervical spondylotic myelopathy (CSM) (OR 0.02, 95% CI 0-0.39, p = 0.009) and respiratory diseases (OR: 23.2, 95% CI 2.35-229.51, p = 0.007) as unfavorable prognostic factor for reintubation.

CONCLUSIONS

Our analysis of patients with cervical spondylosis who received CSS indicated that delayed extubation was associated with the presence of respiratory diseases and CSM, longer operative time, more cervical fusion segments, and longer duration of ICU and hospital stays.

The protective effect of Sanggenol L against DMBA-induced hamster buccal pouch carcinogenesis induces apoptosis and inhibits cell proliferative signalling pathway

BACKGROUND

Oral squamous cell carcinoma (OSCC) has a poor prognosis when treated with surgery and chemotherapy. Therefore, a new therapy and preventative strategy for OSCC and its underlying mechanisms are desperately needed. The purpose of this study was to examine the chemopreventive effects of sanggenol L on oral squamous cell carcinoma (OSCC). The research focused on molecular signalling pathways in 7,12-dimethylbenz(a)anthracene (DMBA)-induced hamster buccal pouch (HBP) carcinogenesis.

AIM

The purpose of this study was to look at the biochemical and chemopreventive effects of sanggenol L on 7,12-dimethylbenz(a)anthracene (DMBA)-induced HBP (hamster buccal pouch) carcinogenesis via cell proliferation and the apoptotic pathway.

METHODS

After developing squamous cell carcinoma, oral tumours continued to progress leftward into the pouch 3 times per week for 10 weeks while being exposed to 0.5 % reactive DMBA three times per week. Tumour growth was caused by biochemical abnormalities that induced inflammation, increased cell proliferation, and decreased apoptosis.

RESULTS

Oral sanggenol L (10 mg/kg bw) supplementation with cancer-induced model DMBA-painted hamsters prevented tumour occurrences, improved biochemistry, inhibited inflammatory markers, decreased cell proliferation marker expression of tumour necrosis factor-alpha (TNF- α), nuclear factor (NF-κB), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and induced apoptosis.

CONCLUSION

Sanggenol L could be developed into a new medicine for the treatment of oral carcinogenesis.

Subtractionless compressed-sensing-accelerated whole-body MR angiography using two-point Dixon fat suppression with single-pass half-reduced contrast dose: feasibility study and initial experience

PURPOSE

To investigate the feasibility and clinical utility of a compressed-sensing-accelerated subtractionless whole-body MRA (CS-WBMRA) protocol with only contrast injection for suspected arterial diseases, by comparison to conventional dual-pass subtraction-based whole-body MRA (conventional-WBMRA) and available computed tomography angiography (CTA).

MATERIALS AND METHODS

This prospective study assessed 86 patients (mean age, 56 years ± 16.4 [standard deviation]; 25 women) with suspected arterial diseases from May 2021 to December 2022, who underwent CS-WBMRA (n = 48, mean age, 55.9 years ± 16.4 [standard deviation]; 25 women) and conventional-WBMRA (n = 38, mean age, 48 years ± 17.4 [standard deviation]; 20 women) on a 3.0 T MRI after random group assignment based on the chronological order of enrolment. Of all enrolled patients administered the CS-WBMRA protocol, 35% (17/48) underwent CTA as required by clinical demands. Two experienced radiologists independently scored the qualitative image quality and venous enhancement contamination. Quantitative image assessment was carried out by determining and comparing the apparent signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of four representative arterial segments. The total examination time and contrast-dose were also recorded. The independent samples t-test or the Wilcoxon rank sum test was used for statistical analysis.

RESULTS

The overall scores of CS-WBMRA outperformed those of conventional-WMBRA (3.40 ± 0.60 vs 3.22 ± 0.55, P < 0.001). In total, 1776 and 1406 arterial segments in the CS-WBMRA and conventional-WBMRA group were evaluated. Qualitative image scores for 7 (of 15) vessel segments in the CS-WMBRA group had statistically significantly increased values compared to those of the conventional-WBMRA groups (P < 0.05). Scores from the other 8 segments showed similar image quality (P > 0.05) between the two protocols. In the quantitative analysis, overall apparent SNRs were significantly higher in the conventional-WBMRA group than in the CS-WBMRA group (214.98 ± 136.05 vs 164.90 ± 118.05; P < 0.001), while overall apparent CNRs were not significantly different in these two groups (CS vs conventional: 107.13 ± 72.323 vs 161.24 ± 118.64; P > 0.05). In the CS-WBMRA group, 7 of 1776 (0.4%) vessel segments were contaminated severely by venous enhancement, while in the convention-WBMRA group, 317 of 1406 (23%) were rated as severe contamination. In the CS-WBMRA group, total examination and reconstruction times were only 7 min and 10 min, respectively, vs 20 min and < 30 s for the conventional WBMRA group, respectively. The contrast agent dose used in the CS-WBMRA protocol was reduced by half compared to conventional-WBMRA protocol (18.7 ± 3.5 ml vs 37.2 ± 5.4 ml, P = 0.008).

CONCLUSION

The CS-WBMRA protocol provides excellent image quality and sufficient diagnostic accuracy for whole-body arterial disease, with relatively faster workflow and half-dose reduction of contrast agent, which has greater potential in clinical practice compared with conventional-WBMRA.

[A comparative study of the curative effects between butterfly-shaped flap and propeller flap based on the dorsal branch of digital artery in repairing the wound in volar aspect of finger]

Objective: To compare the curative effects of butterfly-shaped flap based on the dorsal branch of digital artery (hereinafter referred to as butterfly-shaped flap) and propeller flap based on the dorsal branch of digital artery (hereinafter referred to as propeller flap) in repairing the wound in volar aspect of finger. Methods: A retrospective cohort study was conducted. From August 2018 to April 2022, 16 patients with finger palmar wounds admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine and 7 patients with finger palmar wounds admitted to General Hospital of PLA Central Theater Command met the inclusion criteria, including 14 males and 9 females, aged 25 to 64 years. After debridement or resection of skin benign tumor, the wounds ranged from 0.5 cm×0.5 cm to 1.5 cm×1.5 cm. According to the different rotation axes of flap pedicle during wound repair, the patients were divided into butterfly-shaped flap group (8 cases) and propeller flap group (15 cases), and their wounds were repaired by butterfly-shaped flap (with area of 0.5 cm×0.5 cm-1.5 cm×1.3 cm) or propeller flap (with area of 0.7 cm×0.5 cm-1.5 cm×1.5 cm) , respectively. In propeller flap group, wounds in the donor sites were repaired by full-thickness skin grafts taken from the palms of wrists or the groin. The surgical time, postoperative complications, flap survival, and wound healing time of patients in the two groups were recorded. Data were statistically analyzed with independent sample t test, Mann Whitney U test, or Fisher's exact probability test. Results: The surgical time and postoperative wound healing time of patients in butterfly-shaped flap group ((43±9) min and (13.1±0.8) d, respectively) were both significantly shorter than those in propeller flap group ((87±16) min and (16.7±4.6) d, respectively, with t values of -7.03 and -2.86, respectively, P<0.05). The postoperative flap survival and complications of patients between the two groups were both similar (P>0.05). Conclusions: For repairing the wound in volar aspect of finger, the butterfly-shaped flap has more advantages in comparison with the traditional propeller flap. The butterfly-shaped flap has a short surgical time and fast postoperative recovery, which is worthy of clinical promotion.

An attempt to apply a subtraction model for characterization of non-polar stationary phase in supercritical fluid chromatography

This study verified the feasibility of using a subtraction model to characterize the non-polar stationary phases (including C4, C8, and phenyl-type) in supercritical fluid chromatography (SFC). The model with 6 terms was expressed as log α = η'H + θ'P + β'A + α'B + κ'C + σ'S, where a term θ'P indicating dipole or induced dipole interaction was intentionally supplemented. Ethylbenzene and SunFire C8 were respectively defined as the reference solute and column. A 7-step modeling procedure was proposed: in the first 6 steps, except σ'S, by the use of a bidirectional fitting method, other parameters were calculated based on the equation: log α = log (k_i/k_ref) ≈ η'H + θ'P + β'A + α'B + κ'C; and in the 7th step, residual analysis was employed to describe the σ'S term according to the equation: σ'S = log α_exp. - log α_pre. Furthermore, six columns that were not involved in modeling process and 12 compounds with unknown retention were used for methodology validation. It showed good predictions of log k, as demonstrated by adjusted determination coefficient (R²_adj) from 0.9927 to 0.9998 (column) and from 0.9940 to 0.9999 (compound), respectively. The subtraction model emphasized the contribution of dipole or induced dipole interaction to the retention in SFC, and it obtained the σ'S term through residual analysis. Moreover, it made reasonable physical-chemical sense as the linear solvation energy relationship (LSER) model did, with the distinct advantages of better fitting and more accurate prediction. This study provided some new insights into the characterization of non-polar stationary phases in SFC.

Heavy metals in influent and effluent from 146 drinking water treatment plants across China: Occurrence, explanatory factors, probabilistic health risk, and removal efficiency

Heavy metals (HMs) in drinking water have drawn worldwide attention due to their risks to public health; however, a systematic assessment of the occurrence of HMs in drinking water treatment plants (DWTPs) at a large geographical scale across China and the removal efficiency, human health risks, and the correlation with environmental factors have yet to be established. Therefore, this study characterised the occurrence patterns of nine conventional dissolved HMs in the influent and effluent water samples from 146 typical DWTPs in seven major river basins across China (which consist of the Yangtze River, the Yellow River, the Songhua River, the Pearl River, the Huaihe River, the Liaohe River and the Haihe River) for the first time and removal efficiency, probabilistic health risks, and the correlation with water quality. According to the findings, a total of eight HMs (beryllium (Be), antimony (Sb), barium (Ba), molybdenum (Mo), nickel (Ni), vanadium (V), cobalt (Co) and titanium (Ti)) were detected, with detection frequencies in influent and effluent water ranging from 2.90 (Mo) to 99.30% (Ba) and 1.40 (Ti) to 97.90% (Ba), respectively. The average concentration range was 0.41 (Be)- 77.36 (Sb) μg/L. Among them, Sb (exceeding standard rate 8%), Ba (2.89%), Ni (21.43%), and V (1.33%) were exceeded the national standard (GB5749-2022). By combining Spearman's results and redundancy analysis, our results revealed a close correlation among pH, turbidity (TURB), potassium permanganate index (COD_Mn), and total nitrogen (TN) along with the concentration and composition of HMs. In addition, the concentration of HMs in finished water was strongly affected by the concentration of HMs in raw water, as evidenced by the fact that HMs in surface water poses a risk to the quality of finished water. Metal concentration was the primary factor in assessing the health risk of a single metal, and the carcinogenic risk of Ba, Mo, Ni, and Sb should be paid attention to. In DWTPs, the removal efficiencies of various HMs also vary greatly, with an average removal rate ranging from 16.30% to 95.64%. In summary, our findings provide insights into the water quality and health risks caused by HMs in drinking water.

Kidney Yang Deficiency Syndrome Exacerbates Aβ25-35-Induced Pathological Changes, And Ginsenoside Re Ameliorates Synapse Lesions In Aβ25-35-Injected Rats With Kidney Yang Deficiency Syndrome

BACKGROUND

Traditional Chinese medicine (TCM) indicates that Alzheimer's disease (AD) is considered the consequence produced by Kidney Yang Deficiency Syndrome (KDS-Yang), which has similar clinical characteristics to glucocorticoid withdrawal syndrome. Ginsenoside Re (G-Re) has been found to ameliorate the symptoms and pathological impairments of AD. However, it's not clear whether G-Re could protect memory and synapse lesions against kidney deficiency dementia.

METHODS

Subcutaneous injection of hydrocortisone for 14 days was used to produce KDS-Yang. On the 15th day, Aβ25-35 peptide was injected into the intracerebroventricular (icv) of KDS-Yang rats. Spine density was analyzed by Golgi staining and the ultrastructural morphology of the synapse was detected using Transmission Electron Microscopy (TEM). Western blot was used to examine the expression of pS396, pS404, Tau-5, tGSK-3β, pS9GSK-3β, Syt, Syn I, GluA1, GluN2B, PSD93, PSD95, 2-AR and pS346-2-AR.

RESULTS

Hyperphosphorylation of tau in Aβ25-35-injected rats with KDS-Yang was stronger than in Aβ25-35-injected rats at the sites of Ser396 and Ser404. G-Re improved spatial memory damage detected by Morris water-maze (MWM), enhanced spines density, the thickness of postsynaptic density (PSD) and increased the expression of Syt, Syn I, GluA1, GluN2B, PSD93 and PSD95. Moreover, G-Re decreased the hyperphosphorylation of β2-AR at serine 346 in Aβ25-35-injected rats with KDS-Yang.

CONCLUSION

KDS-Yang might exacerbate AD pathological lesions. Importantly, G-Re is a potential ingredient for protecting against memory and synapse deficits in kidney deficiency dementia.

Extraction and isolation of diphenylheptanes and flavonoids from Alpinia officinarum Hance using supercritical fluid extraction followed with supercritical fluid chromatography

In this paper, an off-line combination method of supercritical fluid extraction and supercritical fluid chromatography was developed for the selective extraction and isolation of diphenylheptanes and flavonoids from Alpinia officinarum Hance. The enrichment of target components was successfully achieved using supercritical fluid extraction with the following conditions (8% ethanol as co-solvent at 45°C and 30 MPa for 30 min). Taking full advantage of the complementarity of supercritical fluid chromatography stationary phases, a two-step preparative supercritical fluid chromatography strategy was constructed. The extract was firstly divided into seven fractions on a Diol column (250 × 20 mm i.d., 10 μm) within 8 min by gradient elution increasing from 5 % to 20 % modifier (methanol) at 55 mL/min and 15 MPa. Then the seven fractions were separated by using a 1-AA or a DEA column (250 × 19 mm i.d., 5 μm) at 50 mL/min and 13.5 MPa. This two-step strategy showed superior separation ability for structural analogues. As a result, seven compounds, including four diphenylheptanes and three flavonoids with high purity, were successfully obtained. The developed method is also helpful for the extraction and isolation of other structural analogs of traditional Chinese medicines. This article is protected by copyright. All rights reserved.

Comprehensive HPLC fingerprint analysis based on a two-step extraction method for quality evaluation of Perilla frutescens (L.) Britt

Abundant chemical components are key to ensure the evaluation accuracy of fingerprint analysis of traditional Chinese medicines (TCMs). A two-step extraction method combining supercritical fluid extraction (SFE) and water ultrasonic extraction was established for the quality evaluation of Perilla frutescens (L.) Britt. Weakly polar components were extracted under optimal SFE conditions (15% co-solvent (EtOH : n-hexane = 1 : 14, (v/v)), 40 °C, 250 bar, and 30 min), and polar components were subsequently extracted by an ultrasonic step (100% water as solvent, 40 °C, and 45 min). Then, HPLC methods were established, which were validated to be accurate, stable, and reliable. In this work, 25 batches of samples were evaluated and the data were analysed by similarity analysis (SA) and hierarchical cluster analysis (HCA). The similarity values of SFE extracts and aqueous extracts were respectively 0.616-0.999, and 0.252-0.997, proving the importance of the extraction method for the accuracy of the subsequent fingerprint analysis results. For the HCA, 25 samples were divided into two categories (leaves and stems), among which four batches of leaves with less similarity were considered as stems, indicating that quality differences of P. frutescens depending on medicinal parts and origin exist. The two-step extraction method developed in this work has been proved to be suitable for the quality evaluation of TCMs with complex compositions.

Efficient strategies for preparative separation of iridoid glycosides and flavonoid glycosides from Hedyotis diffusa

Efficient strategies for the preparative separation of iridoid glycosides and flavonoid glycosides from Hedyotis diffusa using preparative high-performance liquid chromatography combined with appropriate pretreatment technologies were developed. Four fractions (Fr.1-1, Fr.1-2, Fr.1-3, and Fr.2-1) were firstly isolated from the crude extract of Hedyotis diffusa by column chromatography with C18, resin, and silica gel materials, respectively. Then, corresponding separation strategies were developed according to the polarity and chemical constituents. High-polar compounds of Fr.1-1 were purified by hydrophilic reversed-phase liquid chromatography and hydrophilic interaction liquid chromatography mode. The combination of C18 and phenyl columns realized the complementary separation of iridoid glycosides in Fr.1-2. Meanwhile, the improved selectivity caused by the change of organic solvent in the mobile phase was utilized to realize the purification of flavonoid glycosides in Fr.1-3 and Fr. 2-1. Finally, 27 compounds (purity > 95%) mainly involving nine iridoid glycosides and five flavonoid glycosides were obtained. A complete strategy was established for the separation of a complex sample with a wide polarity range, to jointly solve the problems of enrichment of target components and separation of structural analogs.

[Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach]

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

An in-depth investigation of supercritical fluid chromatography retention mechanisms by evaluation of a series of specially designed alkylsiloxane-bonded stationary phases based on linear solvation energy relationship

Fundamental research on supercritical fluid chromatography (SFC) has gained considerable interest, with many studies focusing on its retention mechanism based on the linear solvation energy relationship (LSER) model. In this paper, a series of alkylsiloxane-bonded stationary phases were specifically designed and synthesized, then evaluated using the mobile phase composed of CO₂ with 10% (v/v) methanol. The study demonstrated the close relationship between the interactions (manner and magnitude) of stationary phases and the C-chain length, bonding density and the endcapping treatment. All C8 phases provide positive e, v and negative s, whose magnitude was regularly affected by bonding density. It was worth mentioning the non-endcapped C8 phases could provide H-bonding (positive a and b) by reducing the bonding density of the alkyl chain. Once it was endcapped, the interaction manner did not vary with bonding density adjustment. The non-endcapped C4 phases with higher bonding density could establish additional dispersion interaction (positive v). It can be seen that two synthesis strategies, 1) non-endcapped, long C-chain (C8) combined with low bonding density, and 2) non-endcapped, short C-chain (C4) combined with high bonding density, can obtain the alkylsiloxane-bonded stationary phases (C8-1 and C4-3) to provide both polar and dispersion interactions, showing different separation selectivity. Furthermore, the LSER model with ionic terms was applied to evaluate partial C8 columns, and its rationality was verified. The non-endcapped C8 showed great d⁺ values, which originated from the silanol groups. C8SCX also possessed a great d⁺ value due to the benzenesulfonic acid groups. A remarkable result showed that C8SAX exhibited prominent d^- and d⁺ values simultaneously due to the combined effect of silanol and quaternary ammonium groups, which indicates the unique selectivity when separating ionic compounds. This study provides in-depth insights into the retention mechanism of alkylsiloxane-bonded stationary phases in SFC, as well as a reference for the design of SFC stationary phases.

[Spatiotemporal Distribution and Pollution Risk Assessment of Heavy Metals in Sediments of Main Water Supply Reservoirs in Central Zhuhai City]

The Modaomen and Hongwan waterways are the main estuaries of the Pearl River system. Affected by tides, the Fenghuangshan Reservoir, Dajingshan Reservoir, and Zhuxiandong Reservoir, which are subject to water transfer along the river line, are important drinking water sources in the central part of Zhuhai City in the Guangdong-Hong Kong-Macao Greater Bay Area. Eight heavy metals in 15 sampling points in the reservoir area were monitored in the two seasons (August and October) of 2019. The environmental quality of the surface sediments of the three water supply reservoirs was surveyed using correlation analysis, geoaccumulation index evaluation, ecological risk assessment, and traceability analysis in the present study. The results showed that the order of the average content of the eight heavy metals in the three reservoirs was as follows: Zhuxiandong Reservoir>Dajingshan Reservoir>Fenghuangshan Reservoir. The contents of Hg, Zn, and Pb in Fenghuangshan Reservoir; Hg, As, Mn, Ni, Cu, Zn, and Pb in Dajingshan Reservoir; and Zhuxiandong Reservoir exceeded the background values of soil heavy metals in Guangdong province by 1.88-2.75, 1.05-2.32, and 1.69-6.45 times. Except for As in Fenghuangshan Reservoir, As and Cu in Dajingshan Reservoir and Cr and Ni in Zhuxiandong Reservoir, the other heavy metals elements showed the content characteristics of dry season>wet season. The evaluation results of the geoaccumulation index method indicated that the pollution degree of the three reservoirs was in the order of: Zhuxiandong Reservoir>Dajingshan Reservoir>Fenghuangshan Reservoir. Among them, the Fenghuangshan Reservoir and the Dajingshan Reservoir were only slightly polluted by Hg, Zn, and Pb elements, and the Zhuxiandong Reservoir as a whole was slightly or moderately polluted. The evaluation results of the potential ecological risk index showed that the overall ecological risk of Fenghuangshan Reservoir and Dajingshan Reservoir was low, and Zhuxiandong Reservoir was at a medium ecological risk level. Hg was the main ecological risk-contributing factor of the three reservoirs, with contribution rates of 78.8%, 64.4%, and 51.0%, respectively.

[Structural Characteristics of Phytoplankton Communities and Its Relationship with Environmental Factors in a Group of Drinking Water Reservoirs by Water Transmission from Modaomen Waterway in Zhuhai]

Modaomen Waterway is the main outlet of the Pear River system and an important water source for Zhuhai and Macao. The water quality of 13 sampling sites in Modaomen Waterway, phytoplankton, and environmental factors were investigated at 21 sampling sites in 4 drinking water source groups, which transport water from Modaomen Waterway and connect with each other, in August and October of 2021. A total of 73 genera of phytoplankton in eight phyla were identified, with a total of 150 species, most of them belonging to Cyanophyta, Chlorophyta, and Bacillariophyta. The relative abundance of Cyanophyta was higher than 90% in the DJS and YL reservoirs during flood and dry seasons; Cyanophyta, Chlorophyta, and Bacillariophyta were dominant phyla during different seasons; and their distribution was balanced in the ZXD and ZY reservoirs. The Shannon-Wiener index, Pielous uniformity index, and Margalef richness index showed that the ZY reservoir had the most abundant biodiversity, which indicated the best water quality, followed by the ZXD and YL reservoirs. Conversely, the DJS was the least diverse reservoir for phytoplankton. The PCoA analysis indicated significant differences in plankton structures in ZXD and ZY with the other two reservoirs (P<0.05), respectively. Redundancy analysis (RDA) showed that the main environmental factors affecting the distribution of the phytoplankton community were NO₃^-, TOC, TP, Cl^-, and NH₄⁺-N. These results indicated that the phytoplankton community of the four reservoirs were greatly affected by the nutrient salt caused by water transport, which suggested that the water quality of Modaomen Waterway should be improved to increase reservoir water nutrition to ensure the safety of drinking water sources.

Construction of the prognostic enhancer RNA regulatory network in osteosarcoma

•

Our enhancer RNAs-based prognostic model showed good predictive ability in osteosarcoma.

•

CCAAT enhancer binding protein alpha (CEBPA) may regulate CD8A molecule (CD8A).

•

CD8A activation may promote CD3E molecule (CD3E) expression and activate allograft rejection in CD8+ T cells.

•

Above signal axis provided new insights in the mechanism of osteosarcoma tumorigenesis.

Background

Osteosarcoma (OS) is a common malignant tumor in osteoarticular system, the 5-year overall survival of which is poor. Enhancer RNAs (eRNAs) have been implicated in the tumorigenesis of various cancer types, whereas their roles in OS tumorigenesis remains largely unclear.

Methods

Differentially expressed eRNAs (DEEs), transcription factors (DETFs), target genes (DETGs) were identified using limma (Linear Models for Microarray Analysis) package. Prognosis-related DEEs were accessed by univariate Cox regression analysis. A multivariate model was constructed to evaluate the prognosis of OS samples. Prognosis-related DEEs, DETFs, DETGs, immune cells, and hallmark gene sets were co-analyzed to construct an regulatory network. Specific inhibitors were also filtered by connectivity Map analysis. External validation and scRNA-seq analysis were performed to verify our key findings.

Results

3,981 DETGs, 468 DEEs, 51 DETFs, and 27 differentially expressed hallmark gene sets were identified. A total of Multivariate risk predicting model based on 18 prognosis-related DEEs showed a high accuracy (area under curve (AUC) = 0.896). GW-8510 was the candidate inhibitor targeting prognosis-related DEEs (mean = 0.670, p < 0.001). Based on the OS tumorigenesis-related regulation network, we identified that CCAAT enhancer binding protein alpha (CEBPA, DETF) may regulate CD8A molecule (CD8A, DEE), thereby promoting the transcription of CD3E molecule (CD3E, DETG), which may affect allograft rejection based on CD8+ T cells.

Conclusion

We constructed an eRNA-based prognostic model for predicting the OS patients’ prognosis and explored the potential regulation network for OS tumorigenesis by an integrated bioinformatics analysis, providing promising therapeutic targets for OS patients.

Spatiotemporal variation in nitrogen and phosphorus levels and microbial community in the upstream water transport channel to the Douhe Reservoir

The Douhe Reservoir is an important diversion water source and drinking water resource for Tianjin and the Tangshan cities. Panjiakou, Daheiting, Qiuzhuang, and the Douhe Reservoirs located from top to bottom in the LuanHe River region forming a group of cascade reservoirs. After over 30 years of aquaculture, the concentration of nitrogen (N) and phosphorus (P) have exceeded Class III of Environmental Quality Standard for Surface Water in China. We selected the Douhe Reservoir as the study site and choose sampling points in several upstream reservoirs and main reservoir area, and we collected a total of 18 water samples. Moreover, the distribution characteristics of N and P levels in flood season and dry season were studied in the Douhe Reservoir and upstream water channel, respectively. The results indicated that there were significant spatial differences between N and P distribution in the Douhe Reservoir and the upstream sites. We observed that the distribution of N and P had seasonal characteristics, and the contents of nitrate(NO3^--N), nitrogen(TN), total phosphorus(TP), and total dissolved phosphorus(TDP) in flood periods were higher than those in dry periods. The microbial community structure illustrated that the dominant phylum displayed seasonal differences between the upstream channel and the reservoir area. Among them, the abundance of some genera changed with the location of the channel, the microbial community structure, and the levels of N and P, especially in flood season. Particularly, NO₃^--N and TN had the most significant correlation. Hence, this study presented an important theoretical foundation for the risk prevention and the control of nutrient elements in the LuanHe River basin in the future, which would enhance the drinking water safety of Tianjin and Tangshan residents.

[Pollution Characteristics and Risks of Polycyclic Aromatic Hydrocarbons in Underground and Surface Drinking Water Sources in Northeast Inner Mongolia]

Polycyclic aromatic hydrocarbons (PAHs) are hazardous and ubiquitous pollutants in the aquatic environment, and understanding the pollution characteristics and risk levels of PAHs is of great significance to the sustainable development of drinking water sources and drinking water safety. Hence, PAHs residues were measured qualitatively and quantitatively with solid-phase extraction-gas chromatography-mass spectrometry (SPE-GC-MS) in 33 water samples (including 22 groundwater and 11 surface water samples) of the drinking water sources in the Manzhouli and Xinyouqi areas of northeast Inner Mongolia, and assessments of the pollution level of PAHs and the health and ecological risks were carried out. The results showed that PAHs were detected in all 33 sampling points of Manzhouli drinking water sources, except for benzo[k] fluoranthene, benzo[a] pyrene, and dibenzo[a,h] anthracene, with detection rates ranging from 36.36% to 95.45%; the detection rates of the other 13 PAHs monomers were 100%. The detection range of ρ（ΣPAHs） was 42.76-164.50 ng·L^-1, and the mean value was 90.82 ng·L^-1. The detection ranges of ρ（ΣPAHs） in surface water and groundwater were 66.39-164.50 ng·L^-1 and 42.76-147.70 ng·L^-1, respectively. The concentration of the detected naphthalene was the highest, with a mean value of 36.91 ng·L^-1, and the concentration of anthracene was the lowest, with a mean value of 0.81 ng·L^-1; there were no significant differences among the concentrations of all the PAHs monomers of the surface and groundwater (P>0.05). The pollution of PAHs was at a median level in China and abroad, mainly in the middle and low loops (3-4 loops). The analysis of the sources of PAHs in groundwater and surface water in Manzhouli using the ratio feature method and principal component analysis showed that the PAHs in the drinking water source water bodies in the Manzhouli area were mainly affected by the combustion of coal and biomass and oil, and some surface water sources were affected by the oil source. The human health and ecological risk assessment results showed that the water body of drinking water would not cause health risks to the human body, and the ecological risk was at a medium level; however, the high risk of benzo[b] fluoranthene (BbF) monomer production should be continuous cause for concern. From the perspective of the sustainable development of drinking water sources and drinking water safety, the necessary supervision and protection measures should be considered to prevent further pollution. The results of this research provide a scientific basis for the pollution control and prevention and control of PAHs in drinking water sources.

POS0320 EPIDEMIOLOGY AND HEALTHCARE RESOURCE UTILIZATION OF PATIENTS WITH EGPA IN THE UNITED KINGDOM

Background

Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by eosinophilic inflammation of small with or without medium arteries. EGPA is a rare disease with varying prevalence and incidence rates globally. To date, limited information is available on the prevalence, incidence and burden of disease in the United Kingdom (UK).

Objectives

The objectives were to estimate the prevalence and incidence of EGPA, and to describe the healthcare resource utilization (HCRU) among patients with EGPA in the UK.

Methods

This retrospective database study used the UK-based Clinical Practice Research Datalink (CPRD)-AURUM database linked to the Hospital Episode Statistics (HES). Prevalence was estimated from 2005 to 2019, and incidence was estimated from 2006 to 2019. HCRU was assessed in the 12-months following the first recorded diagnosis of EGPA (index date), and included hospitalizations, emergency room visits, procedures, outpatient specialist visits, primary care visits, and oral corticosteroid use.

Results

764 people were identified with EGPA in the UK. The prevalence of EGPA, reported in the database, increased from 22.7 to 45.6 per 1,000,000 persons from 2005 to 2019 (Figure 1), whereas the incidence of EGPA from 2006 to 2019 ranged from 2.28 to 4.00 per 1,000,000 person-years. 377 patients with EGPA were successfully linked to the CPRD-HES database. Patient characteristics were as follows: mean age (SD) was 57 years (14.2); 49% were male; 81% had asthma; and 11% had peripheral neuropathy prior to the index date. For patients with EGPA, 19% had an EGPA-related hospitalization and 50% had any-cause hospitalization within 1 year of the index date (Table 1). The mean length of stay was, 18 days and 16 days for EGPA-related and any-cause hospitalizations, respectively. 52% of patients with EGPA had undergone a medical procedure, 89% of patients with EGPA had an outpatient visit to a specialist. Almost all patients with EGPA visited a general practitioner within 1 year of their EGPA diagnosis (97%) and averaged 16.0 visits in 1 year. A significant proportion of the EGPA population were prescribed OCS; most EGPA patients had a prescription in the 0–3 months after the index date (64%), and patients on average had a prescription for OCS for 6 out of the 12 months after the index date.

Table 1.

HCRU among patients with EGPA

HCRUNumber of patients N (%) [total days]Number of events per patient, Mean (SD)Total EGPA cohort (N)377 EGPA-specific hospitalizations72 (19.10)1.2 (1) EGPA-specific hospitalizations  length of stay[1283]17.8 (23.3) Any-cause hospitalizations188 (49.87)1.7 (1) Any-cause hospitalizations length of stay[2992]15.9 (23.7) Any-cause A & E events19 (5.04)1.8 (2) Any-cause outpatient visits334 (88.59)9.8 (7) Any procedures undertaken196 (51.99)6.8 (6) General Practitioner visits366 (97.08)16.0 (11)

A&E, Accident and Emergency; EGPA, eosinophilic granulomatosis with polyangiitis; HCRU, healthcare resource utilization.

Figure 1.

Prevalence of EGPA in the UK from 2005 to 2019

Prevalence is expressed as cases per 1,000,000 persons. EGPA, eosinophilic granulomatosis with polyangiitis; UK, United Kingdom.

Conclusion

The prevalence of EGPA increased over the study period in the UK, and the data show significant HCRU within 1 year of the first recorded diagnosis of EGPA. Almost all of the patients with EGPA were found to frequently visit the primary care physician and seek specialist care, and almost half required hospitalization. Funding: GSK [207888]

Acknowledgements

Funding: GSK [207888]

Disclosure of Interests

Jeremiah Hwee Shareholder of: GSK, Employee of: GSK, Qinggong Fu Shareholder of: GSK, Employee of: GSK, Lorraine Harper Speakers bureau: Viopharm (2021), Roche (2017), Consultant of: GSK (2021), Viopharm (2021), Grant/research support from: Viopharm (researcher initiated project), MSD (researcher initiated project), Krishnarajah Nirantharakumar Consultant of: Boehringer Ingelheim (Consultancy on real world evidence), Grant/research support from: AstraZeneca, Vifor and Boehringer Ingelheim (Investigator led grants), Ruchika Goel: None declared, Rupert Jakes Shareholder of: GSK, Employee of: GSK

[Comparison of clinical features between sporadic pancreatic neuroendocrine tumors and those associated with multiple endocrine neoplasia type 1]

Objective: To compare the clinical features of multiple endocrine adenoma type 1 (MEN-1) associated pancreatic neuroendocrine neoplasms (pNENs) as well as sporadic pNENs. Methods: The clinical data of 28 sporadic pNENs patients and 10 MEN-1-related pNENs patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to June 2021 were collected. Meanwhile, by searching PubMed database and reviewing the clinical data of 20 foreign patients with MEN-1-related pNENs which were reported at the same time.Compare and analyze the similarities and differences between MEN1-associated pNENs and sporadic pNENs in clinical features, such as family history, blood tests, pathological diagnostic indicators, tumor grade, stage and metastasis, treatment and prognosis and so on. Results: A total of 58 pNENs patients were included, and there were 30 MEN1-related pNENs patients and 28 sporadic pNENs patients. Eighteen patients (60%) had a family history of MEN1-related pNENs, and the mean age of onset was (35.3±13.0)years. There were no patients (0) with family history of sporadic pNENs, and the mean age of onset was(55.3±13.4)years. In contrast, the differences in family history, age of onset and NSE were statistically significant(all P<0.05).Among the pathological diagnostic indicators, there were 19 patients (63.3%) with Grade G2 of MEN1-related pNENs, and 25 patients (83.3%) with somatostatin receptor 2(SSTR2) negative. In sporadic pNENs, there were 16 patients (57.1%) with Grade G2 and 9 patients (32.1%) with SSTR2 negative. The differences in pathological grade, immunohistochemistry (Chromogranin A, CD56, and somatostatin receptor 2, SSTR2) between the two groups were statistically significant(all P<0.05). In terms of tumor staging and metastasis, 21 patients with MEN-1-related pNENs had metastasis (70%) and 20 patients with stage Ⅰ and Ⅱ AJCC (71%) in all. Eight patients with sporadic pNENs had metastasis (26.7%) and 8 patients were with stage Ⅰ and Ⅱ AJCC (28.6%). By contrast, the differences in total metastasis rate, AJCC stage and distant metastasis between the two groups were statistically significant(all P<0.05). In terms of treatment and prognosis, there was no statistical significance in the differences between surgical treatment and prognosis (P>0.05), and the difference was also not statistically significant in survival rate between them (P>0.05). Conclusions: There are no significant differences between MEN1-related pNENs and sporadic pNENs in terms of treatment, prognosis, and survival rate, but there are significant differences in clinical features, pathological features and the staging and grading of tumors. The rate of tumor grade, stage and metastasis of sporadic pNENs is higher.

[Pollution Characteristics and Risk Assessment of DBPs in Typical Drinking Water Sources in Wuhan Under the COVID-19 Pandemic]

In order to reveal the pollution characteristics and risk levels of DBPs in typical drinking water sources in Wuhan under the COVID-19 pandemic, 26 sampling sites were selected in typical drinking water sources in Wuhan. N,N-diethyl-1,4-phenylenediamine spectrophotometry and gas chromatograph-micro-cell electron capture detector (GC-μECD) methods were used to detect residual chlorine disinfectants and DBPs in water, respectively, and their health and ecology risks were assessed. The results showed that free chlorine or total residual chlorine were detected in 16 of the 26 water samples, and the maximum concentration was 0.04 mg·L^-1, which exceeded the limit of the surface water standard in China. The concentration of residual chlorine was higher in sampling sites near the outfall of a municipal sewage plant. There were 34 types of DBPs measured in 10 sampling sites, and 24 types of substances were detected with the detection rate of 10.00%-100.00%. The ρ (total DBPs) was in the range of 0.11-104.73 μg·L^-1, with an average value of 7.26 μg·L^-1. The concentration of chloroform was the highest among all the DBPs, ranging from 9.98 μg·L^-1 to 11.15 μg·L^-1, with an average value of 10.47 μg·L^-1. The concentration of 2-bromo-2-iodoacetamide was the lowest, ranging from ND-0.11 μg·L^-1, with an average value of 0.01 μg·L^-1. The overall detection level of the DBPs area was low in this study area, and the result of the health risk assessment showed that the DBPs had no carcinogenic or non-carcinogenic health risks to human body. However, the results of the ecological risk assessment showed that chloroform presented a high ecological risk to aquatic organisms.

Comparison of contrast-enhanced T1-weighted imaging using DANTE-SPACE, PETRA, and MPRAGE: a clinical evaluation of brain tumors at 3 Tesla

Background

We aimed to compare the performance of three contrast-enhanced T1-weighted three-dimensional (3D) magnetic resonance (MR) sequences to detect brain tumors at 3 Tesla. The three sequences were: (I) delay alternating with nutation for tailored excitation sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE), (II) pointwise encoding time reduction with radial acquisition (PETRA), and (III) magnetization-prepared rapid acquisition with gradient echo (MPRAGE).

Methods

This study involved 77 consecutive patients, including 34 patients with known primary brain tumors and 43 patients suspected of intracranial metastases. All patients underwent each of the three sequences with comparable spatial resolution and acquisition time post-injection. Signal-to-noise ratios (SNRs) for gray matter (GM) and white matter (WM), contrast-to-noise ratios (CNRs) for lesion/GM, lesion/WM, and GM/WM were quantitatively compared. Two radiologists determined the total number of enhancing lesions by consensus. Intraclass correlation coefficients (ICCs) between the two radiologists for metastases presence, qualitative ratings for image quality, and acoustic noise level of each sequence were assessed.

Results

Among the three sequences, SNRs and CNRs between lesions and surrounding parenchyma were highest using DANTE-SPACE, but CNR_WM/GM was the lowest with DANTE-SPACE. SNRs for PETRA images were significantly higher than those for MPRAGE (P<0.001). CNRs between lesions and surrounding parenchyma were similar for PETRA and MPRAGE (P>0.05). Significantly more brain metastases were detected with DANTE-SPACE (n=94) compared with MPRAGE (n=71) and PETRA (n=72). The ICCs were 0.964 for MPRAGE, 0.975 for PETRA, and 0.973 for DANTE-SPACE. Qualitative scores for lesion imaging using DANTE-SPACE were significantly higher than those obtained with PETRA and MPRAGE (P=0.002 and P=0.004, respectively). The acoustic noise level for PETRA (64.45 dB) was significantly lower than that for MPRAGE (78.27 dB, P<0.01) and DANTE-SPACE (80.18 dB, P<0.01).

Conclusions

PETRA achieves comparable detection of brain tumors with MPRAGE and is preferred for depicting osseous metastases and meningeal enhancement. DANTE-SPACE with blood vessel suppression showed improved detection of cerebral metastases compared with MPRAGE and PETRA, which could be helpful for the differential diagnosis of tumors.

Turbo Gradient and Spin Echo PROPELLER-Diffusion Weighted Imaging for Orbital Tumors: A Comparative Study With Readout-Segmented Echo-Planar Imaging

Purpose: To qualitatively and quantitatively compare the image quality and diagnostic performance of turbo gradient and spin echo PROPELLER diffusion-weighted imaging (TGSE-PROPELLER-DWI) vs. readout-segmented echo-planar imaging (rs-EPI) in the evaluation of orbital tumors.

Materials and Methods: A total of 43 patients with suspected orbital tumors were enrolled to perform the two DWIs with comparable spatial resolution on 3T. The overall image qualities, geometric distortions, susceptibility artifacts, and lesion conspicuities were scored by using a four-point scale (1, poor; 4, excellent). Quantitative measurements, including contrast-to-noise ratios (CNRs), apparent diffusion coefficients (ADCs), geometric distortion rates (GDRs), and lesion sizes, were calculated and compared. The two ADCs for differentiating malignant from benign orbital tumors were evaluated. Wilcoxon signed-rank test, Kappa statistic, and receiver operating characteristics (ROC) curves were used.

Results: TGSE-PROPELLER-DWI performed superior in all subjective scores and quantitative GDR evaluation than rs-EPI (p < 0.001), and excellent interobserver agreement was obtained for Kappa value ranging from 0.876 to 1.000. ADC_lesion of TGSE-PROPELLER-DWI was significantly higher than those of rs-EPI (p < 0.001). Mean ADC of malignant tumors was significantly lower than that of benign tumors both in two DWIs. However, the AUC for differentiating malignant and benign tumors showed no significant difference in the two DWIs (0.860 vs. 0.854, p = 0.7448). Sensitivity and specificity could achieve 92.86% and 72.73% for TGSE-PROPELLER-DWI with a cutoff value of 1.23 × 10^–3 mm²/s, and 85.71% and 81.82% for rs-EPI with a cutoff value of 0.99 × 10^–3 mm²/s.

Conclusion: Compared with rs-EPI, TGSE-PROPELLER-DWI showed minimized geometric distortion and susceptibility artifacts significantly improved the image quality for orbital tumors and achieved comparable diagnostic performance in differentiating malignant and benign orbital tumors.

Isolation of achiral aliphatic acid derivatives from Piper kadsura using preparative two-dimensional chiral supercritical fluid chromatography

The separation of structural analogues in natural products has always been one of the challenges in separation science, where supercritical fluid chromatography (SFC) with chiral stationary phases (CSPs) is an unconventional but potential solution. In this study, a preparative two-dimensional chiral SFC (2D cSFC) method that was established with two kinds of CSPs was applied in the isolation of the aliphatic acid derivatives in Piper kadsura (P. kadsura). The RPLC unseparated peaks of two samples A and B of P. kadsura were evenly scattered on the CSP-1 column while they clustered into two groups on the CSP-2 column by SFC. There was impressively complementary selectivity between CSP-1 and CSP-2, which were used for construction of 2D cSFC. The first dimension (¹D) separation with CSP-1 fractionated the sample A into six parts by a heart-cutting method and the sample B into nine parts for a comprehensive 2D analysis; then 29 and 71 peaks were respectively found in these parts in the second dimension (²D) separation with CSP-2. Further through ²D preparative separation, 19 high purity components were obtained, and the chemical structures of two of them were confirmed, including a novel unsaturated aliphatic acid compound (8Z,10Z)-12-methoxyheptadeca-8,10-dienoic acid and a known octadecadienoic acid lactone Lactariolide. The 2D cSFC method presented the superiority of separating the achiral compounds of complex samples.

Occurrence and risk assessment of volatile organic compounds in multiple drinking water sources in the Yangtze River Delta region, China

Volatile organic compounds (VOCs) are widely present in water environment, which can threaten ecological sustainability and human health. The concentrations of VOCs and their ecological risks in drinking water are of great concern to human beings. Therefore, 54 kinds of VOCs were investigated from 58 locations of the Yangtze River Delta Region (Yangtze River, Qiantang River, Huangpu River, Taihu Lake and Jiaxing Urban River). Out of 54 target compounds, only 31 VOCs were detected, with total concentrations ranging from 0.570 to 46.820 μg/L from 58 locations of all drinking water sources. Among all detected VOCs compounds, only toluene and styrene can cause high-level ecological risk at location TH-2 of Taihu Lake. According to the carcinogenic and non-carcinogenic risk index, compounds such as 1,2-dichloroethane, bromodichloromethane and 1,1,2-trichloroethane posed a higher carcinogenic risk, and 1,2-dichloroethane, trichloroethylene and toluene posed a higher non-carcinogenic risk. Olfactory risks of water bodies in the Yangtze River Delta region are negligible. Although the concentrations of VOCs in the Yangtze River Delta region did not exceed national standards in China and guidelines of the World Health Organization (WHO) for drinking water, the presence of some ecological and health risks indicated that future monitoring studies and control practices are important to ensure ecological safety of drinking water sources.

CT Radiomics Model for Predicting the Ki-67 Index of Lung Cancer： An Exploratory Study

Objective

To establish a radiomics signature and a nomogram model based on enhanced CT images to predict the Ki-67 index of lung cancer.

Methods

From January 2014 to December 2018, 282 patients with lung cancer who had undergone enhanced CT scans and Ki-67 examination within 2 weeks were retrospectively enrolled and analyzed. The clinical data of the patients were collected, such as age, sex, smoking history, maximum tumor diameter and serum tumor markers. Our primary cohort was randomly divided into a training group (n=197) and a validation group (n=85) at a 7:3 ratio. A Ki-67 index ≤ 40% indicated low expression, and a Ki-67 index > 40% indicated high expression. In total, 396 radiomics features were extracted using AK software. Feature reduction and selection were performed using the lasso regression model. Logistic regression analysis was used to establish a multivariate predictive model to identify high and low Ki-67 expression in lung cancer. A nomogram integrating the radiomics score was established based on multiple logistic regression analysis. Area under the curve (AUC) was used to evaluate the prediction efficiency of the radiomics signature and nomogram.

Results

The AUC,sensitivity, specificity and accuracy of the radiomics signature in the training and validation groups were 0.88 (95% CI: 0.82~0.93),79.2%,84.3%,81.2% and 0.86 (95% CI: 0.78~0.94),74.6%,88.1%,79.8%, respectively. A nomogram combining radiomics features and clinical risk factors (smoking history and NSE) was developed. The AUC, sensitivity, specificity and accuracy were 0.87 (95% CI: 0.80~0.95), 75.0%, 90.2% and 83.5% in the validation group, respectively.

Conclusion

The radiomics signature and nomogram based on enhanced CT images provide a way to predict the Ki-67 expression level in lung cancer.

[Prognostic significance of DEK-NUP214 fusion gene in patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To investigate the dynamic change and clinical impact of DEK-NUP214 fusion gene in patients with acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Real-time quantitative polymerase chain reaction (RQ-PCR) and multicolor flow cytometry (FCM) were used to detect DEK-NUP214 gene expression and leukemia-associated immunophenotype (LAIP) in 15 newly diagnosed patients with positive DEK-NUP214 and receiving allo-HSCT from September 2012 to September 2017 at Peking University People's Hospital. The clinical outcome was analyzed using Kaplan-Meier survival curves. The impact of DEK-NUP214 expression was analyzed by log-rank test. Results: The subjects were followed-up with a median period of 657 (62-2 212) days. The median DEK-NUP214 expression level at diagnosis was 488% (274%-1 692%). Thirteen patients achieved complete remission before allo-HSCT. Thirteen patients had a residual DEK-NUP214 expression of 0.38% (0.029%-738.9%) before allo-HSCT. After allo-HSCT, DEK-NUP214 expression in 9/13 patients remained positive, which dropped by around 500 folds (5.7-5 663.0 folds) within a month post-transplant. Five patients died and 2 patients relapsed. The 3-year cumulative incidence of relapse in patients with positive DEK-NUP214 before transplant was 17.5%±11.3% and the 3-year overall survival was 60.5%±13.8%. After allo-HSCT, DEK-NUP214-negative patients had a better outcome. Conclusion: Quantitative monitor of DEK-NUP214 fusion gene could be a sensitive indicator of MRD status after allo-HSCT.

Clinical comparison of single-shot EPI, readout-segmented EPI and TGSE-BLADE for diffusion-weighted imaging of cerebellopontine angle tumors on 3 tesla

OBJECTIVE

The complex anatomical structures of cerebellopontine angle (CPA) pose a unique challenge to diffusion weighted imaging (DWI). This study aimed to compare the clinical utility of the prototypic 2D turbo gradient- and spin echo-BLADE-DWI (TGSE-BLADE-DWI) with that of readout-segmented echo-planar DWI (RESOLVE-DWI) and single-shot echo-planar DWI (SS-EPI-DWI) to visualize CPA anatomic structures and identify CPA tumors.

METHODS

A total of 8 volunteers and 36 patients with pathological CPA tumors were enrolled to perform the three DWI sequences at 3 T. Scan time of TGSE-BLADE-DWI, RESOLVE-DWI and SS-EPI-DWI was 5 min 51 s, 5 min 15 s and 1 min 22 s, respectively. Subjective analysis, including visualization of anatomical structures, geometric distortion, ghosting artifacts, lesion conspicuity, diagnostic confidence, and overall image quality of the three DWI sequences were scored and assessed. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) of CPA tumors were measured and compared.

RESULTS

A total of 39 lesions were identified, TGSE-BLADE-DWI detected all of them, RESOLVE-DWI 36 and SS-EPI-DWI 27. Significant differences were found in all the subjective parameters among the three DWI sequences (all p < 0.001). TGSE-BLADE-DWI was significantly better than RESOLVE-DWI in visualization of CPA anatomical structures, geometric distortion, ghosting artifacts, lesion conspicuity, diagnostic confidence, and overall image quality (all p < 0.01), and RESOLVE-DWI showed significantly superior performance than SS-EPI-DWI in all parameters (all p < 0.001). CNRs and ADCs were not significantly different among the three DWI sequences (p = 0.355, p = 0.590, respectively). No significant differences were detected between TGSE-BLADE-DWI SNR and RESOLVE-DWI SNR (p = 0.058), or TGSE-BLADE-DWI SNR and SS-EPI-DWI SNR (p = 0.155).

CONCLUSION

Compared with RESOLVE-DWI and SS-EPI-DWI, TGSE-BLADE-DWI minimized geometric distortions and ghosting artifacts and demonstrated an improved ability for depicting CPA tumors with better lesion conspicuity.

SUMMARY

Geometric distortions and ghosting artifacts are found at bone-air interfaces using conventional diffusion-weighted imaging (DWI), which is a challenge for imaging cerebellopontine angle (CPA) tumors. Our study validated that geometric distortions and ghosting artifacts were not present on 2D turbo gradient- and spin-echo-BLADE-DWI scans, making this technique useful for visualizing CPA anatomic structures and diagnosing CPA tumors.

Fluorescent and colorimetric dual-mode detection of tetracycline in wastewater based on heteroatoms-doped reduced state carbon dots

A large amount of tetracycline (TC) persists in water, soil, food, and feed due to the overuse of antibiotics, causing serious environmental problems such as damage to ecosystems and posing risks to human health. Thus, there is an urgent need to find a method to detect TC that is practical, rapid, sensitive, and offers ready visualization of TC levels so that adequate remediation measures can be immediately implemented. Herein, we report a fluorescent and colorimetric dual-mode nanosensor for the detection of TC based on reduced state carbon dots (r-CDs). In the presence of TC, the emission fluorescence of r-CDs was quenched by the Förster resonance energy transfer mechanism to achieve high-sensitivity detection of TC with a low limit of detection (LOD) of 1.73 nM. Moreover, TC was also detected by r-CDs via a noticeable color change of the solution (from colorless to red) with the naked eye, having an LOD of 0.46 μM. Furthermore, r-CDs have excellent selectivity and sensitivity in detecting TC in wastewater, and therefore, have practical applications in wastewater treatment. The fluorescent and colorimetric dual-mode proposed in this work may offer a unique idea for the detection of TC, with great prospects for environmental wastewater applications.

Separation and characterization of phenylamides from Piper kadsura using preparative supercritical fluid chromatography and ultra-high-performance supercritical fluid chromatography-tandem mass spectrometry

A preparative supercritical fluid chromatography method for the separation of Piper kadsura obtained five phenylamide compounds, which had the same structural skeleton, but changed in the number and position of methoxyl substituents. To improve the separation selectivity of these structural analogues, silica, phenyl, and chiral stationary phases were screened. Only through the combination of Chiral C and phenyl columns could the separation of the five phenylamides be solved. The two-step strategy using preparative supercritical fluid chromatography presented good orthogonality that ensured the purity of the phenylamides. Then, an ultra-high-performance supercritical fluid chromatography hyphened tandem mass spectrometry method was developed, and the fragmentation pattern of phenylamides was summarized. It mainly cleaved in the amide bond to produce the fragment ion, which could help to judge the substituent positions. Twenty-eight possible molecular weights of hydroxyl and methoxyl substituted phenylamides were calculated and screened. Nine compounds were extracted in three [M + H]⁺ ions at m/z 284.13, 314.13, and 344.13, including five purified compounds and the other four positional or trans-cis phenylamide isomers in low content. The methods developed in this research were useful in the separation and characterization of phenylamide analogues.

POS0885 HIGH INCIDENCE AND MORTALITY OF PNEUMOCYSTIS JIROVECI INFECTION IN ANTI-MDA5-ANTIBODY POSITIVE DERMATOMYOSITIS: EXPERIENCE FROM A SINGLE CENTER

Background:

Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia(PJP) which is potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM.

Objectives:

To investigate the incidence rate and mortality rate of PJP infection in subgroups of IIM patients according to myopathy specific antibodies.

Methods:

In the first part, we reviewed 463 consecutive patients with IIM retrospectively to analyze incidence of PJP infection. In the next part, we enrolled 30 consecutive PJP infection patients with any rheumatic disease was to identify the mortality rate and risk factors. Kaplan-Meier curve with log rank test was used to access differences in survival. Univariate and multivariate analyses were performed to identify prognostic factors using Cox regression.

Results:

We found that 12(7.5%) PJP cases occurred in 160 anti-MDA5-ab-positive DM patients, while only two (0.7%) PJP cases were found in 303 anti-MDA5-ab-negtive DM/PM patients(P < 0.05). PJP infection typically happened in the first two months of the treatment for anti-MDA5-ab-positive DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). Only two (16.7%) anti-MDA5-ab-positive DM patients recover from PJP, with lethally higher mortality than those PJP infection with other rheumatic diseases (83.3% vs. 38.9%, P < 0.05). We found no association between the time to anti-PJP treatment and treatment outcomes in anti-MDA5-ab-positive DM; yet we confirmed in PJP infection with other rheumatic diseases that anti-PJP treatment within 6 days crucially increased the survival (P < 0.05).

Conclusion:

PJP infection has alarming high incidence and mortality in anti-MDA5-ab-positive DM patients. Unlike PJP infection with other rheumatic diseases, timely treatment for PJP doesn’t improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in anti-MDA5-ab-positive DM patients is verified.

References:

[1]Hsu CY, et al. Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study. ARTHRITIS RES THER 2019, 21(1):211.

Acknowledgements:

The authors thank Dr. An Sun,

Disclosure of Interests:

None declared