Dynamic graph transformer network via dual-view connectivity for autism spectrum disorder identification

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that requires objective and accurate identification methods for effective early intervention. Previous population-based methods via functional connectivity (FC) analysis ignore the differences between positive and negative FCs, which provide the potential information complementarity. And they also require additional information to construct a pre-defined graph. Meanwhile, two challenging demand attentions are the imbalance of performance caused by the class distribution and the inherent heterogeneity of multi-site data. In this paper, we propose a novel dynamic graph Transformer network based on dual-view connectivity for ASD Identification. It is based on the Autoencoders, which regard the input feature as individual feature and without any inductive bias. First, a dual-view feature extractor is designed to extract individual and complementary information from positive and negative connectivity. Then Graph Transformer network is innovated with a hot plugging K-Nearest Neighbor (KNN) algorithm module which constructs a dynamic population graph without any additional information. Additionally, we introduce the PolyLoss function and the Vrex method to address the class imbalance and improve the model's generalizability. The evaluation experiment on 1102 subjects from the ABIDE I dataset demonstrates our method can achieve superior performance over several state-of-the-art methods and satisfying generalizability for ASD identification.

Brassica napus BnaA09.MYB52 enhances seed coat mucilage accumulation and tolerance to osmotic stress during seed germination in Arabidopsis thaliana

Seed coat mucilage plays an important role in promoting seed germination under adversity. Previous studies have shown that Arabidopsis thaliana MYB52 (AtMYB52) can positively regulate seed coat mucilage accumulation. However, the role of Brassica napus MYB52 (BnaMYB52) in accumulation of seed coat mucilage and tolerance to osmotic stress during seed germination remains largely unknown. We cloned the BnaA09.MYB52 coding domain sequence from B. napus cv ZS11, identified its conserved protein domains and elucidated its relationship with homologues from a range of plant species. Transgenic plants overexpressing BnaA09.MYB52 in the A. thaliana myb52-1 mutant were generated through Agrobacterium-mediated transformation and used to assess the possible roles of BnaA09.MYB52 in accumulation of seed coat mucilage and tolerance to osmotic stress during seed germination. Subcellular localization and transcriptional activity assays demonstrated that BnaA09.MYB52 functions as a transcription factor. RT-qPCR results indicate that BnaA09.MYB52 is predominantly expressed in roots and developing seeds of B. napus cv ZS11. Introduction of BnaA09.MYB52 into myb52-1 restored thinner seed coat mucilage in this mutant to levels in the wild type. Consistently, expression levels of three key genes participating in mucilage formation in developing seeds of myb52-1 were also restored to wild type levels by overexpressing BnaA09.MYB52. Furthermore, BnaA09.MYB52 was induced by osmotic stress during seed germination in B. napus, and ectopic expression of BnaA09.MYB52 successfully corrected sensitivity of the myb52-1 mutant to osmotic stress during seed germination. These findings enhance our understanding of the functions of BnaA09.MYB52 and provide a novel strategy for future B. napus breeding.

An EEG Study on β-γ Phase-Amplitude Coupling-Based Functional Brain Network in Epilepsy Patients

Epilepsy, a chronic neuropsychiatric brain disorder characterized with recurrent seizures, is closely associated with abnormal neural communications within the brain. Despite that the phase-amplitude coupling (PAC) has been suggested to offer a new way to observe neural interactions during epilepsy, however, few studies pay attention to alterations of the epileptic functional brain network based on PAC, especially on the β-γ PAC. Therefore, we use scalp electroencephalography (EEG) data of epileptic patients and the β-γ PAC modulation index (MI) to construct functional brain networks to examine variations of neural interactions during different epileptic phases. Statistically, the findings show that between-channel MI values in the post-ictal period significantly increase compared to that in the pre-ictal period, and the between-channel MI value has a close association with the information of phase and amplitude provided by the channels. Importantly, in both the phase-amplitude and amplitude-phase functional brain networks, the average node degree is remarkably higher in the post-ictal period than that in the pre-ictal period, whereas the characteristic path length in the ictal and post-ictal periods is significantly lower than that in the pre-ictal period. Besides, the average betweenness centrality in the post-ictal period is remarkably higher than that in the ictal period. Interestingly, the positive correlations between within-channel MI values and between-channel MI values can be observed during the pre-ictal, ictal and post-ictal periods. These findings suggest that the β-γ PAC-based functional brain network may provide a novel perspective to understanding alterations of neural interactions during the epileptic evolution, and may contribute to effectively controlling the spread of epileptic seizures.

Is polyethylene glycol loxenatide 100 μg the preferred glucagon-like peptide-1 receptor agonist for type 2 diabetes mellitus? A meta-analysis and trial sequential analysis

OBJECTIVE

This study aimed to systematically evaluate the efficacy, safety and optimal dose of polyethylene glycol loxenatide (PEX168) for treating type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Clinical trials of PEX168 for T2DM were identified in 8 databases, with a build time limit of January 2023. Included studies were subjected to meta-analysis and trial sequential analysis (TSA).

RESULTS

On the efficacy endpoint, the meta-analysis showed that PEX168 100 μg significantly reduced 0.86% glycated hemoglobin type A1c (HbA1c) (MD -0.86, 95% CI -1.02 - -0.70,  p<0.00001), 1.11 mmol/L fasting plasma glucose (FPG) (MD -1.11, 95% CI -1.49 - -0.74, p<0.00001) and 1.91 mmol/L 2h postprandial glucose (PPG) (MD -1.91, 95% CI -3.35 - -0.46, p=0.01) compared with placebo. The TSA showed that all these benefits were conclusive. On safety endpoints, total adverse events (AEs), gastrointestinal (GI) AEs, serious AEs, and hypoglycemia were comparable to placebo for PEX168 100 μg (p>0.05). In the dose comparison, the HbA1c, FPG, and 2h PPG of PEX168 200 μg were comparable to 100 μg (p>0.05), while GI AEs were significantly higher than 100 μg (RR=2.84, 95% CI 1.64-4.93,  p=0.0002).

CONCLUSIONS

PEX168 100 μg can significantly lower blood glucose and does not increase the risk of total AEs, GI AEs, and hypoglycemia, which may be a preferred glucagon-like peptide-1 receptor agonist for type 2 diabetes mellitus.

[Association between remnant cholesterol levels and incident diabetic retinopathy in middle-aged and older patients with diabetes]

Objective: To investigate the association between remnant cholesterol (RC) and the risk of diabetic retinopathy (DR) in middle-aged and older individuals with diabetes. Methods: Based on the Shanghai Nicheng Cohort Study database, the data of 1 255 individuals with diabetes aged 55-70 years at baseline (2013-2014) with complete fundus photographs and serum cholesterol data in Nicheng, Shanghai, were analyzed. Multinomial logistic regression models were used to evaluate risk ratios (RRs) and their 95% confidence intervals (CIs) between baseline RC level and incident DR. Results: The median age of the subjects was 61.9 years, and 60.4% were women. After a 4.6-year follow-up, 79 (6.3%) patients developed DR, including 50 (4.0%) mild non-proliferative DR and 29 (2.3%) referable DR (RDR). Multivariable logistic regression showed that each mmol/L increase of RC was associated with a 40% higher risk of RDR (RR=1.40, 95%CI 1.03-1.90). Compared with the lowest tertile of RC (<0.63 mmol/L), the risk of RDR in the highest tertile (≥0.85 mmol/L) increased by 4.59 times (RR=5.59, 95%CI 1.51-20.73). Conclusion: The RC level may help identify individuals at high risk of incident RDR in middle-aged and older Chinese adults with diabetes.

High Dose Hyperfractionated Thoracic Radiotherapy vs. Standard Dose for Limited Stage Small-Cell Lung Cancer: A Multicenter, Open-Label Randomized, Phase 3 Trial

PURPOSE/OBJECTIVE(S)

Limited stage small-cell lung cancer (LS-SCLC) is associated with poor prognosis. We aimed to assess the efficacy and safety of high-dose, hyperfractionated thoracic radiotherapy of 54 Gy in 30 fractions compared with standard dose (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC.

MATERIALS/METHODS

The study was an open-label, randomized, phase 3 trial, done at 16 public hospitals in China. Key inclusion criteria were patients aged 18-70 years, with previously histologically or cytologically confirmed LS-SCLC, previously untreated or received 1-2 courses of intravenous cisplatin (75 mg/m²of body-surface area, on day 1 or divided into two days of each cycle) or carboplatin (area under the curve of 5 mg/mL per min, day 1 of each cycle)and intravenous etoposide (100 mg/m²of body-surface area, on days 1-3 of each cycle), and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions or the simultaneous integrated boost VMAT (SIB-VMAT) of 54 Gy in 30 fractions to the primary lung tumor and lymph node metastases starting 0-42 days after the first chemotherapy course. Both groups of patients received thoracic radiotherapy twice per day and 10 fractions per week. Prophylactic cranial radiation (PCI, 25 Gy in 10 fractions) was implemented to patients with responsive disease. The primary endpoint was overall survival. Safety was analyzed in the as-treated population.

RESULTS

Between June 30, 2017, and April 6, 2021, 224 eligible patients were enrolled and randomly assigned to 54 Gy (n = 108) or 45 Gy (n = 116). Median follow-up for the primary analysis was 45 months (IQR 41-48). Median overall survival was significantly improved in the 54 Gy group (62.4 months) compared with the 45 Gy group (43.1 months; p = 0.001). Median progression-free survival was significantly improved in the 54 Gy group (30.5 months) compared with the 45 Gy group (16.7 months; p = 0.044). The most common grade 3-4 adverse events were neutropenia (30 [28%] of 108 patients in the 54 Gy group vs 27 [23%] of 116 patients in the 45 Gy group), neutropenic infections (6 [6%] vs 2 [2%]), thrombocytopenia (13 [12%] vs 12 [10%]), anemia (6 [6%] vs 4 [3%]), and esophagitis (1 [1%] vs 3 [3%]). Treatment-related serious adverse events occurred in 9 [8%] patients in the 54 Gy group and 16 [14%] patients in the 45 Gy group. There were one treatment-related deaths in 54 Gy group (myocardial infarction).

CONCLUSION

Compared with standard thoracic radiotherapy dose of 45 Gy, the high dose of 54 Gy improved overall survival and progression-free survival without increasing toxicities in patients with LS-SCLC, supporting twice-daily hyperfractionated thoracic radiotherapy of 54 Gy with concurrent chemotherapy is an alternative treatment option for LS-SCLC. This study is complete and registered with ClinicalTrials.gov, NCT03214003.

Sparsity-guided multiple functional connectivity patterns for classification of schizophrenia via convolutional network

The explorations of brain functional connectivity network (FCN) using resting-state functional magnetic resonance imaging can provide crucial insights into discriminative analysis of neuropsychiatric disorders, such as schizophrenia (SZ). Pearson's correlation (PC) is widely used to construct a densely connected FCN which may overlook some complex interactions of paired regions of interest (ROIs) under confounding effect of other ROIs. Although the method of sparse representation takes into account this issue, it penalizes each edge equally, which often makes the FCN look like a random network. In this paper, we establish a new framework, called convolutional neural network with sparsity-guided multiple functional connectivity, for SZ classification. The framework consists of two components. (1) The first component constructs a sparse FCN by integrating PC and weighted sparse representation (WSR). The FCN retains the intrinsic correlation between paired ROIs, and eliminates false connection simultaneously, resulting in sparse interactions among multiple ROIs with the confounding effect regressed out. (2) In the second component, we develop a functional connectivity convolution to learn discriminative features for SZ classification from multiple FCNs by mining the joint spatial mapping of FCNs. Finally, an occlusion strategy is employed to explore the contributive regions and connections, to derive the potential biomarkers in identifying associated aberrant connectivity of SZ. The experiments on SZ identification verify the rationality and advantages of our proposed method. This framework also can be used as a diagnostic tool for other neuropsychiatric disorders.

A model description of beta oscillations in the external globus pallidus

The external globus pallidus (GPe), a subcortical nucleus located in the indirect pathway of the basal ganglia, is widely considered to have tight associations with abnormal beta oscillations (13-30 Hz) observed in Parkinson's disease (PD). Despite that many mechanisms have been put forward to explain the emergence of these beta oscillations, however, it is still unclear the functional contributions of the GPe, especially, whether the GPe itself can generate beta oscillations. To investigate the role played by the GPe in producing beta oscillations, we employ a well described firing rate model of the GPe neural population. Through extensive simulations, we find that the transmission delay within the GPe-GPe pathway contributes significantly to inducing beta oscillations, and the impacts of the time constant and connection strength of the GPe-GPe pathway on generating beta oscillations are non-negligible. Moreover, the GPe firing patterns can be significantly modulated by the time constant and connection strength of the GPe-GPe pathway, as well as the transmission delay within the GPe-GPe pathway. Interestingly, both increasing and decreasing the transmission delay can push the GPe firing pattern from beta oscillations to other firing patterns, including oscillation and non-oscillation firing patterns. These findings suggest that if the transmission delays within the GPe are at least 9.8 ms, beta oscillations can be produced originally in the GPe neural population, which also may be the origin of PD-related beta oscillations and should be regarded as a promising target for treatments for PD.

Multi-Graph Attention Networks with Bilinear Convolution for Diagnosis of Schizophrenia

The explorations of brain functional connectivity (FC) network using resting-state functional magnetic resonance imaging (rs-fMRI) can provide crucial insights into discriminative analysis of neuropsychiatric disorders such as schizophrenia (SZ). Graph attention network (GAT), which could capture the local stationary on the network topology and aggregate the features of neighboring nodes, has advantages in learning the feature representation of brain regions. However, GAT only can obtain the node-level features that reflect local information, ignoring the spatial information within the connectivity-based features that proved to be important for SZ diagnosis. In addition, existing graph learning techniques usually rely on a single graph topology to represent neighborhood information, and only consider a single correlation measure for connectivity features. Comprehensive analysis of multiple graph topologies and multiple measures of FC can leverage their complementary information that may contribute to identifying patients. In this paper, we propose a multi-graph attention network (MGAT) with bilinear convolution (BC) neural network framework for SZ diagnosis and functional connectivity analysis. Besides multiple correlation measures to construct connectivity networks from different perspectives, we further propose two different graph construction methods to capture both the low- and high-level graph topologies, respectively. Especially, the MGAT module is developed to learn multiple node interaction features on each graph topology, and the BC module is utilized to learn the spatial connectivity features of the brain network for disease prediction. Importantly, the rationality and advantages of our proposed method can be validated by the experiments on SZ identification. Therefore, we speculate that this framework may also be potentially used as a diagnostic tool for other neuropsychiatric disorders.

Assessing the Readiness for Implementing the World Health Organization's ICOPE Approach in Hong Kong: Perspectives from Social Care and Policy Stakeholders

Although integrated care has been considered a key strategy in reforming health systems around the world, it seems hard to realise in practice, particularly in the part of medical social integration. Worse still, little is known about the capacity of social care professionals who implement it, or their perceived roles and responsibilities, as well as the barriers and facilitators that stakeholders from the health and social sectors identify as factors affecting the ICOPE implementation process. Therefore, the present study was performed to probe into these issues. Data were collected from an online survey based on the WHO ICOPE scorecard (N = 34), and focus groups with policy makers, managers, health and social care professionals (N = 47). Inductive analyses were performed in accordance with the service and system levels within the WHO ICOPE implementation framework. While the findings from the scorecard survey highlight the gap in actualizing the ICOPE approach within the existing social services and care structures, we found support for a model of integrated care underpinned by the WHO ICOPE approach. Factors that may hinder and facilitate ICOPE implementation include workforce capacity-building, coordinated networks and partnerships, and financial mechanisms. This finding can help inform subsequent actions that further support health and social care advancement and collaboration, and the implementation of the ICOPE approach.

A Dyadic Cooking-Based Intervention for Improving Subjective Health and Well-Being of Older Adults with Subjective Cognitive Decline and Their Caregivers: A Randomized Controlled Trial

OBJECTIVES

Evidence on the effectiveness of cooking activities as a well-being promotion intervention for older adults with subjective cognitive decline (SCD) and their caregivers is scarce. In view of this, a randomized controlled trial was conducted to examine whether a dyadic cooking-based intervention can improve the subjective health and well-being of older adults with SCD and their caregivers, as well as the cooking competence of the former group.

DESIGN

Randomized controlled trial.

SETTING

Community.

PARTICIPANTS

Sixty pairs of community-dwelling older adults aged 60 years or above with SCD (mean age = 78.4 years) and their caregivers (mean age = 65.3 years) were randomly assigned to the intervention group (N = 30 pairs) and the wait-list control group (N = 30 pairs).

INTERVENTION

The intervention was an innovative 5-week (two hours per week) dyadic cooking-based intervention employing procedural learning methods specifically adapted for older adults with SCD.

MEASUREMENTS

The outcome measures included 1) a well-being index composed by four indicators: life satisfaction, feeling of happiness, sense of purpose and meaning in life, and perceived health, and 2) cooking competence.

RESULTS

For both older adults with SCD and their caregivers, the increases in the well-being index were significantly greater in the intervention group than in the control group (β = 0.508, 95% CI [0.036, 0.980]). For older adults with SCD, the increases in the cooking competence score were significantly greater in the intervention group than in the control group (β = 1.629, 95% CI [0.165, 3.071]).

CONCLUSION

The dyadic cooking-based intervention resulted in improvements in the cooking competence and well-being of older adults with SCD, as well as the well-being of caregivers.

Trajectories of Intrinsic Capacity: Determinants and Associations with Disability

OBJECTIVES

Intrinsic capacity (IC) declines progressively with age, thereby increasing the risk of disability. However, it is less known whether IC trajectories are associated with disability. This study aims to identify the different patterns of IC trajectories in older people, and examine their determinants and associations with Instrumental Activities of Daily Living (IADL).

DESIGN

Cohort study.

SETTING

Community centres in different regions in Hong Kong.

PARTICIPANTS AND MEASUREMENTS

Longitudinal data from community-dwelling older people aged 60 years or above (n = 1371) collected between 2016 and 2021 was analysed. Their mean age was 74.5 years, and 78.7% of them were female. Repeated measurements of a set of 14 self-reported items were used to generate IC scores at four time points using a bi-factor model. Latent class growth analysis was performed to identify classes with distinct IC trajectories. The association between class membership and IADL disability was then examined using logistic regression.

RESULTS

Three distinct IC trajectories were identified. The 1st class included those with the highest level of baseline IC and the least declining trajectory, whereas the 3rd class was composed by those with the lowest level of baseline IC and the most declining trajectory. Older age, female gender, lower perceived financial adequacy, living in public or subsidized housing, and chronic diseases were associated with the 3rd class. After adjusting for demographic factors, socioeconomic status, and the number of chronic diseases, the 1st class was more likely to preserve IADL when compared against the 2nd class, with OR being 3.179 (95% CI: 2.152-4.793), whereas for the 3rd class, the OR was 0.253 (95% CI: 0.178-0.359).

CONCLUSION

Monitoring IC trajectories is of relevance to clinical practice, as it helps shift the focus from treating acute episodes of illness to preserving the functional ability of older people.

Moving towards the ICOPE Approach: Evaluation of Community-Based Intervention Activities on Improving Intrinsic Capacity

OBJECTIVES

Different types of community-based intervention activities may have differential effects in improving the intrinsic capacity (IC) of older people. This study aims to (i) identify subgroups of older people based on their IC impairments, (ii) examine the differential associations between different types of activity participations and change in IC across subgroups, and (iii) assess whether the activity participation patterns of older people align with the way that would benefit them the most.

METHODS

Participants were community-dwelling older people aged 60 years or above. They were screened for IC impairments at baseline, and their participation records of different types (cognitive, physical, nutritional, mental, and social) of intervention activities were collected for one year. An aggregated IC score was created based on four IC domains including cognitive (self-rated memory), locomotor (self-rated difficulties in walking), vitality (self-rated weight loss), and psychological (subjective well-being). Cluster analysis was used to group homogenous participants. Mixed-effects regression was used to examine the associations between activity counts (i.e., number of sessions participated) and change in IC. Activity participation patterns were also compared across subgroups.

RESULTS

Data were obtained from 7,357 participants (mean age = 74.72 years). Four clusters were identified, including those who were relatively robust (cluster 1, N = 4,380, 59.5%), those who had cognitive decline (cluster 2, N = 2,134, 29.0%), those who had impaired mobility and vitality (cluster 3, N = 319, 4.3%), and those with poor psychological well-being (cluster 4, N = 524, 7.1%). Overall, activity count was associated with IC improvement (β = 0.073, 95% CI [0.037, 0.108]). However, as regards the cluster-specific results, different types of activities were associated with IC improvement for different specific clusters. For instance, cognitive activity count was associated with IC improvement only for cluster 2 (β = 0.491, 95% CI [0.258, 0.732]). Notably, none of the activity types were associated with IC improvement for cluster 1. Regarding the activity participation patterns, there were no significant differences across the four clusters (Wilk's Λ = 0.997, F = 1.400, p = .138).

CONCLUSIONS AND IMPLICATIONS

IC improvement depended on the activity types and IC status of older people. In view of this, a people-centred and targeted approach should be adopted to maximize the overall benefits of intervention activities.

Lactation time influences the composition of Bifidobacterium and Lactobacillus at species level in human breast milk

Human breast milk is a source of microorganisms for infants that play an important role in building infant gut health and immunity. The bacterial composition in human breast milk is influenced by lactation time. This study aimed to investigate the influence of lactation time on bacteria in breast milk at the genus level and the species levels of Bifidobacterium and Lactobacillus on days 2-4, 8, 14, and 30. Eighteen individuals were recruited and 60 milk samples were collected. The 16S rRNA gene, and the bifidobacterial groEL and lactobacilli groEL genes were used for amplicon sequencing. The results revealed that the alpha diversities of colostrum and transition 1 (day 8) milk were lower than that of transition 2 (day 14) and mature milk. PCoA analysis showed that bacterial composition in colostrum and transition 1 milk differed from transition 2 and mature milk. A lower relative abundance of Blautia was found in colostrum and transition 1 milk compared with mature milk and lower abundances of Ruminococcus, Dorea, and Escherichia-Shigella were found in transition 1 compared with mature milk. Bifidobacterium ruminantium, Limosilactobacillus mucosae, and Ligilactobacillus ruminis were the predominant species across all four lactation stages, while Bifidobacterium bifidum was lower in transition 1, and Bifidobacterium pseudocatenulatum and Bifidobacterium pseudolongum were higher in transition 1 milk. This study indicated that the bacterial composition in colostrum was more similar to that of transition 1 milk, whereas the bacterial community in transition 2 milk was similar to that of mature milk which suggests that bacterial composition in human breast milk shows stage-specific signatures even within a short period at both genus level and Bifidobacterium and Lactobacillus species levels, providing insights into probiotic supplementation for the nursing mother.

Temporal-spatial dynamic functional connectivity analysis in schizophrenia classification

With the development of resting-state functional magnetic resonance imaging (rs-fMRI) technology, the functional connectivity network (FCN) which reflects the statistical similarity of temporal activity between brain regions has shown promising results for the identification of neuropsychiatric disorders. Alteration in FCN is believed to have the potential to locate biomarkers for classifying or predicting schizophrenia (SZ) from healthy control. However, the traditional FCN analysis with stationary assumption, i.e., static functional connectivity network (SFCN) at the time only measures the simple functional connectivity among brain regions, ignoring the dynamic changes of functional connectivity and the high-order dynamic interactions. In this article, the dynamic functional connectivity network (DFCN) is constructed to delineate the characteristic of connectivity variation across time. A high-order functional connectivity network (HFCN) designed based on DFCN, could characterize more complex spatial interactions across multiple brain regions with the potential to reflect complex functional segregation and integration. Specifically, the temporal variability and the high-order network topology features, which characterize the brain FCNs from region and connectivity aspects, are extracted from DFCN and HFCN, respectively. Experiment results on SZ identification prove that our method is more effective (i.e., obtaining a significantly higher classification accuracy, 81.82%) than other competing methods. Post hoc inspection of the informative features in the individualized classification task further could serve as the potential biomarkers for identifying associated aberrant connectivity in SZ.

POS0744 SYSTEMIC LUPUS ERYTHEMATOSUS WITH ACTIVE MUSCULOSKELETAL SYMPTOMS: PATIENT REPORTED SYMPTOM IMPACT, TREATMENT PATTERNS AND SATISFACTION WITH CURRENT THERAPY OPTIONS

Background

Musculoskeletal (MSK) symptoms affect 50-95% of patients with SLE over their disease course negatively impacting functioning, and quality of life (QoL).1 In SLE-UPDATE, a US, cross-sectional, non-interventional online survey of adults with SLE, over half of the participants reported active MSK symptoms, including pain or swelling in the joints (53%) and stiffness (57%).2 The present study evaluated the sub-group of participants with ‘currently active’ MSK symptoms.

Objectives

To describe the self-reported disease burden, treatment patterns, and satisfaction with therapies in patients with SLE, comparing those with versus without active MSK symptoms.

Methods

This secondary analysis of SLE-UPDATE survey data stratified participants into active or non-active MSK group. Participants currently experiencing pain or swelling and/or stiffness in their joints and had a Joint Pain NRS > 4 were in the “active MSK group”. All remaining participants were in the “non-active MSK group”. Analysis comprised descriptive statistics, mean (standard deviation [SD]) for continuous variables, and frequency (percentage [%]) for categorical variables. Two-sample t-test to compare mean scores and chi-squared testing to compare proportions were used.

Results

Of the survey participants, 285 were in the active MSK group and 215 in the non-active MSK group. The active MSK group was older (44.3 vs. 40.2 years, <0.001) and had a longer time since diagnosis (12.6 vs. 9.2 years, <0.001). More people in the MSK group had fibromyalgia (FM) (45 vs 12%, <0.0001), worse pain, fatigue, and QoL (Table 1) suggestive of Type 2 non-inflammatory SLE symptoms. Fewer in the MSK group were employed full-time (36.5 vs. 62.8%) and more were on permanent disability (27.0 vs. 6.5%). More participants in the active MSK group negatively assessed their general health (fair or poor) over the last month (53.4 vs. 20.4%). The active MSK group self-reported more “flares” over the prior 3 months; with 44.9 vs 41.9% reporting 1-3 flares, 15.1 vs 5.1% reporting 4-6 flares, and 8.1 vs 2.3% reporting > 7 flares.

Table 1.

Patient Reported Outcomes

Active MSKNon-Active MSKFMNon-FMFMNon-FMN=129N=156N=26N=189Worst Pain NRS, Mean (SD)6.5 (1.7)*4.8 (2.6)6.9 (1.6)*6.2 (1.8)4.0 (2.2)4.9 (2.6)~Worst Joint Pain NRS, Mean (SD)6.7 (1.7)*4.5 (2.6)7.1 (1.6)*6.5 (1.6)3.5 (2.0)4.6 (2.6)*FACIT Fatigue Score, Mean (SD)19.1 (10.8)*28.1 (11.6)15.4 (9.5)*22.1 (10.9)25.7 (13.8)28.4 (11.3)~LupusPRO HRQoL Score (SD)48.9 (20.2)*64.1 (23.0)45.5 (18.1)*51.7 (21.4)63.0 (23.9)64.3 (22.9)~

NRS: 0 (none)-10 (worst imaginable); FACIT Fatigue: 0-52, higher= less fatigue; LupusPRO: 0-100, higher= better QoL; *p < 0.05; ~ Not significant

The active MSK group used more anti-malarials (50.9 vs. 30.7%), immunosuppressants (37.2 vs. 26.5%), including methotrexate (12.6 vs 3.3%), narcotic analgesics (18.6 vs. 10.2%), and topicals for joint pain (30.5 vs. 10.2%). Interestingly, treatment goals of greatest importance in both groups were reduction in fatigue and pain, but pain reduction had higher importance in active MSK group (rated very important by 26.7 vs. 18.1%). Lower proportions in the active MSK group were satisfied with steroids (58.0 vs. 77.8% <0.01), immunosuppressants (65.1 vs. 80.7% <0.05), methotrexate (47.2 vs. 85.7% =0.061), and belimumab (80 vs. 95.5%=0.102).

Conclusion

Reduction of pain and fatigue was the main treatment goal of patients with SLE whether they had active or non-active MSK symptoms. Patients with active MSK symptoms had higher pain and fatigue, lower QoL, and less satisfaction with current therapies compared to SLE patients without active MSK symptoms, driven only in part by co-morbid FM. Findings from these analyses suggest there are unmet needs to better understand MSK manifestations, their overlap with Type 2 SLE symptoms, align patient/physician priorities, and improve therapies for MSK symptoms for patients with SLE.

References

[1]Mahmoud K. Curr Opin Rheumatol 2017;29:486-492

[2]Birt J. Rheum Ther 2021;8:1189-1205

Acknowledgements

The authors would like to thank the Lupus Foundation of America for their support with the design of the survey.

Disclosure of Interests

Diane L Kamen: None declared, Julie Birt Shareholder of: Shareholder of Eli Lilly & Company, Employee of: Employee of Eli Lilly & Company, Monica Hadi Grant/research support from: Evidera received funding to conduct this research, Elizabeth Gibbons Grant/research support from: Evidera received funding to conduct this research, Don Bushnell Grant/research support from: Evidera has received funding for the conduct of this research, Ren Yu Grant/research support from: Evidera has received funding to conduct this research, Laure Delbecque Shareholder of: Shareholder of Eli Lilly, Employee of: Employee of Eli Lilly, Kirstin Griffing Shareholder of: Eli Lilly & Company shareholder, Employee of: Eli Lilly & Company paid employee, Anca Askanase Grant/research support from: Investigator for GSK, AZ, Pfizer, Idorsia, Eli Lilly

[Associations between gene polymorphisms of signal transducer and activator of transcription 3 and the susceptibility to hepatitis B virus related liver cirrhosis]

To investigate the associations between gene polymorphisms of signal transducer and activator of transcription 3 (STAT3) and liver cirrhosis (LC) after hepatitis B virus (HBV) infection. A case-control study was conducted in 243 patients with hepatitis B cirrhosis (HBV-LC, case group) and 486 HBV-infected subjects without LC (non-LC, control group) collected from January 2018 to September 2020 at the Changsha Central Hospital Affiliated to Nanhua University. Three single nucleotide polymorphisms (SNPs) of STAT3 gene, including rs4796793C>G, rs2293152C>G, and rs1053004T>C were selected through literature and biological information database, and the genotypes were detected by real-time fluorescent quantitative PCR (RFQ-PCR). The distribution differences of STAT3 SNPs genotypes between the two groups were compared using Chi-square test and haplotype analysis was conducted by Shesis online. The proportion of HBV C genotype in HBV-LC patients was significantly higher than that in the control group (80.91% vs. 70.79%, χ²=7.109, P=0.008), while the logarithm of ALT was significantly lower than that of the control group (1.78±0.43 vs. 1.95±0.54, t=3.801, P=0.000). The genotypes distributions of rs4796793, rs2293152, and rs1053004 were not significantly different between HBV-LC and non-LC in overall analysis and stratified analysis by gender (χ²=2.610, 1.505, 0.586, 2.653, 2.685, 1.583, 0.351, 5.388, 0.339, respectively, P>0.05 for each). Among the subjects infected with HBV genotype C, rs1053004 CC (vs. TT) significantly increased the risk of HBV-LC [odds ratio (OR) = 1.40, 95% confidence interval (CI): 1.03-1.91]. Among the HBV-infected subjects with HBeAg negative, rs4796793 GG genotype (vs. CC) and G allele (vs. C) significantly increased the risks of HBV-LC (OR = 2.17, 95%CI: 1.11-4.23; OR = 1.45, 95%CI: 1.06-1.97, respectively). Haplotypes analysis showed that the frequency of haplotype C-G-T composed of rs4796793, rs2293152, and rs1053004 was significantly lower in HBV-LC than that in the control group (non-LC) (27.3% vs. 35.6%, χ²=9.949, P = 0.001). The correlation between STAT3 and HBV-LC is different in HBV-infected subjects with different infection status. The HBV-infected subjects carrying haplotype rs4796793C-rs2293152G-rs1053004T of STAT3 gene have significantly decreased risk of LC.

Real-world circulating tumor DNA analysis depicts resistance mechanism and clonal evolution in ALK inhibitor-treated lung adenocarcinoma patients

Background

Sequential treatment with different generations of anaplastic lymphoma kinase (ALK) inhibitors have been widely applied to ALK-positive lung cancer; however, resistance mutations inevitably developed. Further characterization of ALK resistance mutations may provide key guidance to subsequent therapies. Here we explored the emergence of secondary ALK mutations during sequential ALK tyrosine kinase inhibitor (TKI) treatment in a real-world study of Chinese lung adenocarcinoma (ADC) patients.

Methods

A clinical-genomic database was queried for lung ADC patients with at least one ALK inhibitor treatment and at least one plasma sample collected following ALK inhibitor treatment. Targeted genome profiling was performed with a 139-gene panel in baseline tumor tissue and serial plasma samples of patients.

Results

A total of 116 patients met inclusion criteria. ALK G1202R was more common in patients with echinoderm microtubule-associated protein-like 4 (EML4)-ALK v3 fusion, whereas ALK L1196M was more common in v1. TP53 mutant patients were significantly associated with harboring multiple ALK resistance mutations (P = 0.03) and v3+/TP53 mutant patients had the highest rate of multiple ALK resistance mutations. The sequential use of ALK TKI led to an increased incidence of concurrent ALK mutations along the lines of therapies. Alectinib had a lower rate (9%) harboring ALK resistance mutation as first-line ALK TKI compared with crizotinib (36%). ALK compound mutations identified included ALK D1203N/L1196M, ALK G1202R/L1196M, and ALK G1202R/F1174C, which may be lorlatinib resistant. Using paired pretreatment and post-treatment samples, we identified several ALK-independent resistance-related genetic alterations, including PTPRD and CNKN2A/B loss, MYC, MYCN and KRAS amplification, and EGFR^19del.

Conclusions

Sequential postprogression plasma profiling revealed that increased lines of ALK inhibitors can accelerate the accumulation of ALK resistance mutations and may lead to treatment-refractory compound ALK mutations. The selection for optimal first-line TKI is very important to achieve a more efficacious long-term strategy and prevent the emergence of on-target resistance, which may provide guidance for clinical decision making.

•

ALK resistance mutations were differentially enriched in the setting of EML4-ALK v1/v3 and TP53 status.

•

Serial liquid biopsies NGS depicted accumulation of multiple ALK secondary mutations during sequential ALK treatments.

•

Several lorlatinib-resistant ALK compound mutations and ALK-independent resistance genetic alterations were identified.

Dietary Patterns and Intrinsic Capacity in Community-Dwelling Older Adults: A Cross-Sectional Study

OBJECTIVES

Few studies have investigated the link between diet and intrinsic capacity (IC), and the potential sex difference in such association. This study examined the association between dietary patterns and IC and its sub-domains in Chinese community-dwelling older adults.

DESIGN

Cross-sectional analysis using baseline data from the MrOs and MsOs study.

SETTING

Community.

PARTICIPANTS

Chinese community-dwelling older adults aged ≥65 years in Hong Kong.

MEASUREMENTS

Dietary intake was assessed using a validated food frequency questionnaire and priori and posteriori dietary pattern scores were generated. IC including measures of cognitive, locomotor, vitality, sensory and psychological domains was assessed. Multiple logistic regression was performed to examine the associations between dietary pattern scores and the likelihood of greater IC and sub-domain scores with adjustment for sociodemographic and lifestyle factors.

RESULTS

Data of 3730 participants (aged 72.2±5.0 years, 50.4% men) was available. In men, higher Diet Quality Index-International (DQI-I) and Okinawan diet scores, and lower "meat-fish" pattern scores were associated with greater IC. A higher DQI-I score was associated with greater locomotion, whereas higher "snacks-drinks-milk products" pattern score was associated with a greater sensory function. In women, none of the dietary pattern scores was associated with IC. Higher DQI-I score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score and "vegetables-fruits" pattern score were associated with greater psychological function.

CONCLUSION

Various dietary patterns were associated with greater IC and its sub-domains in Chinese community-dwelling older adults, and more associations were observed in men than women. Strategies to improve diet and IC should take sex differences into account.

Towards Healthy Ageing: Using the Concept of Intrinsic Capacity in Frailty Prevention

OBJECTIVES

To examine whether intrinsic capacity (IC) could predict frailty, whether declines in specific domains of IC could lead to frailty, and whether different combinations of domains could represent different risks of developing frailty.

SETTING

Community.

PARTICIPANTS

Chinese people aged 65 years and older.

MEASUREMENTS

Using data from a prospective cohort study, we derived a summary score for IC and scores for the five domains (cognitive, locomotor, vitality, sensory, psychological) for each participant at baseline. Frailty was assessed according to the Fried's frailty phenotype at baseline, 2- and 4-year follow-ups. Participants were classified as frail if they had ≥3 of the following criteria: weight loss, self-rated exhaustion, weakness, slow walking speed, and low physical activity.

RESULTS

Four thousand participants were interviewed at baseline. Overall mean age was 72.5 years; 50% were women. Between baseline and the 2-year follow-up, 5.7% of non-frail participants developed frailty; between 2- and 4-year follow-ups, 5.7% of non-frail participants developed frailty. The average annual incidence rate of frailty was 2.9%. Higher scores on IC at baseline were associated with a lower risk of incident frailty at both follow-ups (year 2, odds ratio (OR)=0.64, 95% confidence interval (CI)=0.59-0.71); year 4, OR=0.64, 95%CI=0.58-0.71) after adjustment for age, sex, educational level, and chronic diseases. Across the five domains, vitality was the strongest predictor of incident frailty at each follow-up (year 2, OR=0.33, 95%CI=0.24-0.45; year 4, OR=0.33, 95%CI=0.23-0.46). Compared to other combinations of any two domains, having 'high' scores on both vitality and locomotor domains was associated with the lowest risk of incident frailty (year 2, OR=0.11, 95%CI=0.06-0.22, area under the curve (AUC)=0.770; year 4, OR=0.18, 95%CI=0.10-0.32, AUC=0.782).

CONCLUSION

This study provides evidence that IC was independently associated with incident frailty. It also finds that vitality was the domain most strongly associated with incident frailty. Finally, it suggests that optimizing multiple domains of IC, particularly vitality and locomotor, may prevent frailty.

Outcome prediction of unconscious patients based on weighted sparse brain network construction

It is quite challenging to establish a prompt and reliable prognosis assessment for acquired brain injury (ABI) patients with persistent severe disorders of consciousness (DOC) like unconscious comatose and unresponsive wakefulness syndrome (a.k.a., vegetative state). Recent advances in brain functional imaging and functional net-work analysis have demonstrated its potential in determining the consciousness level and prognostic outcome for ABI patients with DOC. However, the diagnostic and prognostic usefulness of the whole-brain functional connectome based on advanced machine learning techniques has not been fully evaluated. The first aim of this study is to predict the outcome of individual unconscious ABI patients during a three-month follow-up. The second aim is to conduct precise individualized differentiation among different consciousness levels for exploring the neurobiological mechanisms underlying DOC. Based on resting-state fMRI, we construct large-scale functional networks by using a weighted sparse model, which ensures sparsity and interpretability by preserving strong functional connections. The functional connection strengths are exploited as features for outcome prediction and consciousness level differentiation. We achieve significantly improved consciousness level classification (accuracy: 84.78%) and recovery outcome prediction (accuracy: 89.74%) compared to other network construction methods. More importantly, we reveal the contributive connections across the entire brain in both tasks. These connections could serve as the potential biomarkers for better understanding of consciousness and further provide new insight into the development of diagnostic, prognostic, and effective therapeutic guidelines for ABI patients with DOC.

[Differential diagnosis of pure ground glass nodules in lung with spectral CT imaging]

Objective: To evaluate the differential diagnostic performance of quantitative parameters derived from the spectral CT imagingin pure ground-glass nodules. Methods: A total of 44 patients with pure ground glass nodules underwent chest energy spectrum CT and with known subsequently pathological findings in the Imaging Department of the Second Affiliated Hospital of Soochow University from August 2017 to September 2019 were retrospectively analyzed. Among them, there are 18 males and 26 females, aged from 26 to 79 (51±12) years. They were divided into as the inflammatory group (n=12), pre-invasive adenocarcinoma group (n=17) and invasive adenocarcinoma group (n=15). The aforementioned three groups were further reclassified as non-invasive adenocarcinoma group (inflammatory lesion+pre-invasive lesion) and invasive adenocarcinoma group in order to evaluating the values of water concentration (WC) for the determination of adenocarcinoma infiltration status. The values of WC derived from the arterial and venous phase of the lesion, iodine concentration (IC), standardized iodine concentration (NIC) were measured respectively.The slope of the energy spectral curve (K_40-70KeV) derived from the arterial and venous phase of the lesion was also calculated. One-way ANOVA analysis was performed to compare the differences of the three groups and the multiple comparison method was used for further comparing. Intraclass correlation efficient (ICC) was used to assess the consistency of the three times of measurements. The area under curve(AUC) of Receiver Operating Characteristic (ROC) was conducted to evaluate the diagnostic performance of water based values. Results: The values of WC in the arterial and venous phases were significantly different. As in the inflammatory group, the pre-invasive lesion group and the invasive adenocarcinoma group, the values of WC was (291.95±58.66) mg/cm³, (297.61±63.96) mg/cm³and (374.52±60.62) mg/cm³ of the arterial phase, and (277.07±33.78) mg/cm³, (291.74±50.49) mg/cm³ and (373.33±75.12) mg/cm³ of the venous phase, respectively(all P<0.05). Further comparison demonstrated that no significant difference was observed for the values of WC derived from the arterial phases and venous phases between the inflammatory lesion group and the pre-invasive lesion group (all P>0.05).There were an significant differences between the invasive adenocarcinoma group, the inflammatory lesion group and the pre-invasive lesion group (all P<0.05). The values of WC derived from the venous phase achieved the largest AUC (0.770) for differentiating invasive adenocarcinoma from non-invasive adenocarcinoma (inflammatory lesions+pre-invasive lesions) in the pure ground glass nodules. The sensitivity and specificity were 66.67% and 93.10%, respectively, when using 349.31 mg/cm³ as the optimal threshold. The slope of the spectral curve and iodine-related parameters (IC, NIC) derived from arterial or venous phases among the three groups were not significantly different (all P>0.05). Conclusion: The values of WC derived from the spectral CT can better distinguish inflammatory, pre-invasive lesions and invasive adenocarcinoma, which is helpful for the qualitative analysis for pure ground glass nodules.

[Correlation study between changes in intestinal microflora structure and immune indexes in newly treated patients with pulmonary tuberculosis]

To explore the correlation between the changes of the intestinal flora of newly treated pulmonary tuberculosis patients and the immune indicators of the body, and to provide a reference for the prevention and treatment of pulmonary tuberculosis. A single-center and case-control study was adopted. From October 2020 to April 2021, 43 patients with newly diagnosed tuberculosis in the Department of Tuberculosis, Affiliated Changsha Central Hospital,University of South China were selected as the control group. 43 cases of newly treated pulmonary tuberculosis (PTB), 43 healthy control (HC) during the same period, collected fresh feces and whole blood of subjects, and used Illumina Hiseq high-throughput sequencing technology to analyze 16S of all microorganisms in feces The V4 region of rRNA was amplified and sequenced, and the structure of the intestinal flora was analyzed by QIIME software. Use flow cytometry to determine the subject's immune indicators (CD3⁺, CD4⁺, CD8⁺, CD4⁺CD25⁺CD127^-Treg, CD14⁺CD16⁺, CD14⁺CD16^-), and analyze the changes in intestinal flora and immune function in newly treated pulmonary tuberculosis patients Inherent connection. The χ² test, t test, and Wilcox rank sum test were used to analyze the differences in age, gender, α diversity, and relative abundance of the two groups of people. Compared with the HC group, the alpha diversity of the intestinal flora in the PTB group decreased (shannon index: t=3.906, P=0.000 2; simpson index: Z=553, P=0.004 7; chao1 index: t=5.395, P=0.000 0). β diversity analysis showed that there were significant differences in the structure of the intestinal flora between the two groups (P=0.000). Species difference analysis showed that at the phylum level, the relative abundance of Firmicutes in the PTB group was significantly lower than that in the HC group (Z=486.0, P=0.000 5). At the genus level, there are 15 different bacterial genera between the two groups. In the PTB group, bifidobacterium, enterococcus, lactobacillus, anaerostipes, the relative abundance of the above 5 genera of veillonella is higher than that of the HC group (P<0.05); Butyricimonas, clostridium, and broutella (blautia), coprococcus, dorea, lachnospira, roseburia, faecalibacterium, ruminococcus, the relative abundance of 10 bacterial genera including dialister was lower than that of the HC group (P<0.05). Comparison of immune indexes between groups showed that CD14⁺CD16⁺monocytes (%) in the PTB group were higher than those in the HC group (t=2.456, P=0.001 6<0.05), while CD14⁺CD16^-monocytes (%) were lower than HC (t=-4.368, P=0.000<0.05), while the differences in CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺and Treg (CD4⁺CD25⁺CD127^-) were not statistically significant (P>0.05). Spearman correlation analysis showed that Firmicutes in the PTB group was negatively correlated with CD4⁺/CD8⁺, CD14⁺CD16⁺(r=-0.218, P=0.048; r=-0.245, P=0.025), and positively correlated with CD14⁺CD16^-Correlation (r=0.250, P=0.022); At the genus level, Faecalis is positively correlated with CD4⁺/CD8⁺and CD4⁺(r=0.250, P=0.023; r=0.258, P=0.019); Rosella and CD3⁺, CD8⁺and CD14⁺CD16^-are positively correlated (r=0.27, P=0.024; r=0.219, P=0.046; r=0.027, P=0.039), and negatively correlated with CD14⁺CD16⁺(r=-0.280, P= 0.01). Changes in the structure of the intestinal flora of newly treated pulmonary tuberculosis patients may be one of the influencing factors of the immune function of the body. Targeted optimization of the structure of the intestinal flora and improvement of the body's immunity may be used as an effective auxiliary treatment for pulmonary tuberculosis.

Hypocomplementemia (C3) as an independent predictor for children with acute post-streptococcal glomerulonephritis: a long-term observation

OBJECTIVE

The aim of this study was to examine the altering patterns in clinical characteristics and severity of acute post-streptococcal glomerulonephritis (APSGN) in children.

PATIENTS AND METHODS

We analyzed the medical records of 119 children who were diagnosed with APSGN from 1987 to 2018, retrospectively. The patients were divided into two groups: Group I (n=72, before 1998) and Group II (n=47, after 1998). Clinical, radiologic, and laboratory findings were compared between the two groups.

RESULTS

The clinical manifestations, including vomiting (20.8% vs. 4.3%, p=0.014), oliguria (40.3% vs. 19.1%, p=0.016), and generalized edema (86.1% vs. 63.8%, p=0.005), were statistically less frequent since 1998. Pulmonary edema on chest X-ray (22.7% vs. 4.4%, p=0.014) was less frequent in Group II than in Group I. The level of BUN (23.3±19.3 vs. 18.8±11.2, p=0.009) was lower in Group II than in Group I, while that of creatinine was not significantly different between the two groups. C3 level was an independent factor for predicting the development of edema (odds ratio [OR]: 1.034, 95% CI: 1.010-1.060, p=0.006) and acute nephritic symptoms (≥2) (OR: 0.974, 95% CI: 0.952-0996, p=0.020). It was also negatively correlated with an increasing number of acute nephritic symptoms, including oliguria and edema, in patients with APSGN (R=-0.182, p=0.048).

CONCLUSIONS

This study demonstrated that APSGN had favorable clinical manifestations and severity over the past 30 years. The monitoring of C3 levels can be used to assess the disease severity and risk of complications, including edema and oliguria, which are decreasing in South Korean children.

Assessing alfalfa (Medicago sativa L.) tolerance to salinity at seedling stage and screening of the salinity tolerance traits

Salt is among the most harmful agents that negatively influences crop yield. Alfalfa is an important perennial forage crop that exhibits wide cultivar variations in salt tolerance. Developing salt-tolerant alfalfa plants is a promising way to utilize salinized land. A comprehensive method was developed to achieve reliable and effective evaluation of alfalfa salt resistance. This included principal components, membership functions and cluster and stepwise regression analyses. These were used to analyse the salt tolerance coefficients of 14 traits and to evaluate 20 diverse alfalfa cultivars at the seedling stage. The various morphological root parameters of six alfalfa cultivars with contrasting salt tolerance were also tested by a scanning apparatus. According to the comprehensive evaluation value (D value), one highly salt-tolerant, two salt-tolerant, four moderately salt-tolerant and 13 salt-sensitive alfalfa cultivars were screened. A mathematical equation for the evaluation of alfalfa salt tolerance was established: D' = -0.126 + 0.667SFW + 0.377SDW + 1.089K⁺ /Na⁺  + 0.172SFW/RFW (R²  = 0.988; average forecast accuracy of 96.95%), where four indices were closely related to the salt tolerance: shoot fresh weight, ratio of shoot fresh weight to root fresh weight, shoot dry weight and ratio of K⁺ to Na⁺ in the shoot. We also found that SSA correlated strongly with SFW, SDW, K⁺ /Na⁺ , D values, while SRV correlated obviously with SFW, SFW/RFW and D values after 150 mm NaCl treatment. In conclusion, the SFW, K⁺ /Na⁺ , SDW, SFW/RFW, SSA and SRV could be used as indicators of salt tolerance in alfalfa seedlings grown under 150 mm NaCl treatment.

Dual Orbital Degeneracy Lifting in a Strongly Correlated Electron System

The local structure of NaTiSi_{2}O_{6} is examined across its Ti-dimerization orbital-assisted Peierls transition at 210 K. An atomic pair distribution function approach evidences local symmetry breaking preexisting far above the transition. The analysis unravels that, on warming, the dimers evolve into a short range orbital degeneracy lifted (ODL) state of dual orbital character, persisting up to at least 490 K. The ODL state is correlated over the length scale spanning ∼6 sites of the Ti zigzag chains. Results imply that the ODL phenomenology extends to strongly correlated electron systems.

Physics-informed machine learning: case studies for weather and climate modelling

Machine learning (ML) provides novel and powerful ways of accurately and efficiently recognizing complex patterns, emulating nonlinear dynamics, and predicting the spatio-temporal evolution of weather and climate processes. Off-the-shelf ML models, however, do not necessarily obey the fundamental governing laws of physical systems, nor do they generalize well to scenarios on which they have not been trained. We survey systematic approaches to incorporating physics and domain knowledge into ML models and distill these approaches into broad categories. Through 10 case studies, we show how these approaches have been used successfully for emulating, downscaling, and forecasting weather and climate processes. The accomplishments of these studies include greater physical consistency, reduced training time, improved data efficiency, and better generalization. Finally, we synthesize the lessons learned and identify scientific, diagnostic, computational, and resource challenges for developing truly robust and reliable physics-informed ML models for weather and climate processes. This article is part of the theme issue 'Machine learning for weather and climate modelling'.

Factors Affecting Trends in Societal Indicators of Ageing Well in Hong Kong: Policies, Politics and Pandemics

OBJECTIVES

To document the trend in a quality of life indicator for the older Hong Kong population as an assessment of the impact of age friendly city policies, political conflicts and the covid-19 pandemic.

DESIGN

Random telephone survey and collection of government data over four years (2017-2020).

SETTING

Community living older people.

PARTICIPANTS

People aged 50 years and over.

MEASUREMENTS

The Hong Kong Quality of Life Index covering four domains of in income security, health status, capability and enabling environment.

RESULTS

From 2017-9, improvements were seen in various domains in parallel with the adoption of the World Health Organization's Age Friendly City concept by government policy together with a territory wide initiative supported by a major philanthropic organization. However scores of all domains dropped markedly as a result of political conflicts as well as the onset of the pandemic.

CONCLUSION

The documentation of the trend in HKEQOL shows that while it may be used as a macro indicator that is able to reflect policies affecting the well-being of older people, it is also able to reflect the impact of societal unrest and pandemics, and that the latter may override the effect of existing ageing policies. It also follows that during social unrest and pandemics, specific policies targeting older people may be needed to maintain well-being.

Validation of the Construct of Intrinsic Capacity in a Longitudinal Chinese Cohort

OBJECTIVES

We examined the structure and predictive ability of intrinsic capacity in a cohort of Chinese older adults.

METHODS

We used data from the MrOS and MsOS (Hong Kong) study, which was designed to examine the determinants of osteoporotic fractures and health in older Chinese adults. We analysed baseline and the 7-year follow-up data using exploratory factor analysis, confirmatory factor analysis (CFA), and mediation analysis.

RESULTS

The study consisted of 3736 participants at baseline (mean 72.2 years), with 1475 in the 7-year follow-up. Bi-factor CFA revealed five sub-factors labelled as 'cognitive', 'locomotor', 'vitality', 'sensory', and 'psychological' and one general factor labelled as 'intrinsic capacity'. The model fits the data well, with Root Mean Square Error of Approximation (RMSEA)=0.055 (90% CI=0.053-0.058) for the 5-factor model and RMSEA=0.031 (90% CI=0.028-0.035) for the bi-factor model. Significantly lower intrinsic capacity scores were found in older age groups, women, as well as those who had lower levels of education, lower subjective social status, reported more chronic diseases, or a higher number of IADL limitations (All p<0.0001). Intrinsic capacity had a direct effect in predicting incident IADL limitations at the 7-year follow-up (β=-0.21, p<0.001). The effect was larger than the direct effect of the number of chronic diseases on incident IADL limitations (β=0.05, not significant).

CONCLUSIONS

This study supports the construct and predictive validity of the proposed capacity domains of intrinsic capacity. The findings could inform the development of an intrinsic capacity score that would facilitate implementation of the concept of intrinsic capacity in clinical practice.

Neighborhood Social Cohesion Associates with Loneliness Differently among Older People According to Subjective Social Status

OBJECTIVES

To examine whether neighborhood social cohesion can alleviate the negative impact of low subjective social status on feelings of loneliness.

DESIGN

Cross-sectional study.

SETTING

Community, Hong Kong.

PARTICIPANTS

Older people who participated in a cohort study on osteoporosis and general health in Hong Kong (MrOs study).

METHODS

Data were sourced from the 14-year follow-up data of the MrOs study. Loneliness was measured using the 6-item De Jong Gierveld Loneliness Scale. Neighborhood social cohesion was measured by the Hong Kong version of Neighborhood Cohesion Instrument. Linear regression models were used to examine the associations between neighborhood social cohesion and loneliness, controlled for age, sex, marital status, educational level, lifestyle, number of diseases, and maximum lifetime income. The analyses were stratified by subjective social status as measured by a 10-rung self-anchoring scale.

RESULTS

1,037 participants with a mean age of 83 years were included in the study, of whom 72%, 83%, and 64% were classified as at risk of overall loneliness, emotional loneliness, and social loneliness, respectively. Those who were classified as at risk of overall loneliness reported lower subjective social status and had lower levels of neighborhood social cohesion. Linear regression models showed that higher levels of neighborhood social cohesion were associated with lower levels of overall and social loneliness. Stratified analyses showed that the associations between neighborhood social cohesion and loneliness vary across subjective social status groups. Among those with low/middle social status ranking, higher levels of neighborhood social cohesion were associated with lower overall (low-ranking B=-0.111, p=0.001; middle-ranking B=-0.057, p=0.026) and social (low-ranking B=-0.093, p<0.001; middle-ranking B=-0.073, p<0.001) loneliness scores. Among those with high ranking, higher levels of neighborhood social cohesion were associated with lower overall (B=-0.099, p=0.041) and emotional (B=-0.056, p=0.017) loneliness scores, but the associations became insignificant when controlling for maximum lifetime income.

CONCLUSIONS AND IMPLICATIONS

Neighborhood social cohesion may operate differently in different social ranking groups. Interventions to alleviate feelings of loneliness should be subjective social status specific.

Insights on the role of external globus pallidus in controlling absence seizures

Absence epilepsy, characterized by transient loss of awareness and bilaterally synchronous 2-4 Hz spike and wave discharges (SWDs) on electroencephalography (EEG) during absence seizures, is generally believed to arise from abnormal interactions between the cerebral cortex (Ctx) and thalamus. Recent animal electrophysiological studies suggested that changing the neural activation level of the external globus pallidus (GPe) neurons can remarkably modify firing rates of the thalamic reticular nucleus (TRN) neurons through the GABAergic GPe-TRN pathway. However, the existing experimental evidence does not provide a clear answer as to whether the GPe-TRN pathway contributes to regulating absence seizures. Here, using a biophysically based mean-field model of the GPe-corticothalamic (GCT) network, we found that both directly decreasing the strength of the GPe-TRN pathway and inactivating GPe neurons can effectively suppress absence seizures. Also, the pallido-cortical pathway and the recurrent connection of GPe neurons facilitate the regulation of absence seizures through the GPe-TRN pathway. Specifically, in the controllable situation, enhancing the coupling strength of either of the two pathways can successfully terminate absence seizures. Moreover, the competition between the GPe-TRN and pallido-cortical pathways may lead to the GPe bidirectionally controlling absence seizures, and this bidirectional control manner can be significantly modulated by the Ctx-TRN pathway. Importantly, when the strength of the Ctx-TRN pathway is relatively strong, the bidirectional control of absence seizures by changing GPe neural activities can be observed at both weak and strong strengths of the pallido-cortical pathway.These findings suggest that the GPe-TRN pathway may have crucial functional roles in regulating absence seizures, which may provide a testable hypothesis for further experimental studies and new perspectives on the treatment of absence epilepsy.

Increased expression of CXCL2 in ACPA-positive rheumatoid arthritis and its role in osteoclastogenesis

Anti-citrullinated protein/peptide antibodies (ACPA) play important roles in the pathogenesis of rheumatoid arthritis (RA). ACPA-positive (ACPA⁺ ) and ACPA-negative (ACPA^- ) RA were suggested to be different disease subsets, with distinct differences in genetic variation and clinical outcomes. The aims of the present study were to compare gene expression profiles in ACPA⁺ and ACPA^- RA, and to identify novel candidate gene signatures that might serve as therapeutic targets. Comprehensive transcriptome analysis of peripheral blood mononuclear cells (PBMCs) from ACPA⁺ and ACPA^- RA patients and healthy controls was performed via RNA sequencing. A validation cohort was used to further investigate differentially expressed genes via polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). Spearman's correlation test was used to evaluate the correlation of differentially expressed genes and the clinical and laboratory data of the patients. The role of differentially expressed genes in osteoclastogenesis was further investigated. Expression of C-X-C motif chemokine ligand 2 (CXCL2) was significantly increased in ACPA⁺ RA than in ACPA^- RA, which was validated in PBMCs and serum. CXCL2 promoted the migration of CD14⁺ monocytes and increased osteoclastogenesis in RA patients. RAW264.7 macrophages were used to investigate specific mechanisms, and the results suggested that CXCL2 stimulated osteoclastogenesis via extracellular receptor kinase (ERK) mitogen-activated protein kinase (MAPK) and nuclear factor kappa B pathways. In conclusion, CXCL2 was highly expressed in ACPA⁺ RA than in ACPA^- RA. CXCL2 promoted osteoclastogenesis and was related to bone erosion in RA, which suggests that the blockade of CXCL2 might be a novel strategy for the treatment of RA.

A toolbox for brain network construction and classification (BrainNetClass)

Brain functional network has been increasingly used in understanding brain functions and diseases. While many network construction methods have been proposed, the progress in the field still largely relies on static pairwise Pearson's correlation-based functional network and group-level comparisons. We introduce a "Brain Network Construction and Classification (BrainNetClass)" toolbox to promote more advanced brain network construction methods to the filed, including some state-of-the-art methods that were recently developed to capture complex and high-order interactions among brain regions. The toolbox also integrates a well-accepted and rigorous classification framework based on brain connectome features toward individualized disease diagnosis in a hope that the advanced network modeling could boost the subsequent classification. BrainNetClass is a MATLAB-based, open-source, cross-platform toolbox with both graphical user-friendly interfaces and a command line mode targeting cognitive neuroscientists and clinicians for promoting reliability, reproducibility, and interpretability of connectome-based, computer-aided diagnosis. It generates abundant classification-related results from network presentations to contributing features that have been largely ignored by most studies to grant users the ability of evaluating the disease diagnostic model and its robustness and generalizability. We demonstrate the effectiveness of the toolbox on real resting-state functional MRI datasets. BrainNetClass (v1.0) is available at https://github.com/zzstefan/BrainNetClass.

[Study on the expression of non-coding microRNA-376b-3p in serum exosomes of patients with malignant glioma and the mechanism of anti-angiogenesis]

Objective: To screen the different microRNAs in the serum exosomes of patients with malignant glioma, to explore the effect of non-coding microRNA-376b-3p (miR-376b-3p) on the proliferation, invasion and tumor vasculogenic mimicry of glioma cells, and to verify its targeting effect on HOXD10. Methods: HiSeq/MiSeq high-throughput sequencing was used to screen the different microRNA expression profiles, target genes and action pathways in the serum exosomes of patients with malignant glioma. Samples were used to evaluate the expression of candidate microRNAs in serum exosomes of high-grade gliomas. The effects of miR-376b-3p on the proliferation, invasion and angiogenesis of glioma cells were detected by MTT assay, Transwell migration assay and Matrigel vasculogenic mimicry assay. The mRNA and protein expression of HOXD10 were detected to evaluate the regulatory effect of miR-376b-3p on it. Results: There were 144 different expression microRNAs in the serum exosomes between malignant glioma and the normal control. Focal adhesion and tumor protein polysaccharides were involved in the regulation of glioma enriched by KEGG(Kyoto Encyclopedia of Genes and Genomes). MiR-376b-3p was down regulated in malignant glioma, and AUC of malignant glioma was 0.85 (P<0.01). MTT test showed that the proliferation ability of miR-376b-3p inhibitor group was higher than that of the control group, and that of miR-376b-3p mimic group was lower than that of the control group. Transwell migration test showed that the number of transmembrane cells in miR-376b-3p inhibitor group was higher than that in NC inhibitor group, and the number of transmembrane cells in miR-376b-3p mimic group was lower than that in NC mimic group. The number of tubes of vasculogenic mimicry in miR-376b-3p mimic group was lower than that in NC mimic group. MiR-376b-3p inhibitor decreased the expression level of HOXD10 mRNA and protein, and miR-376b-3p mimic increased the expression level of HOXD10 mRNA and protein. Conclusions: MiR-376b-3p is down-regulated in the serum exosomes of malignant glioma patients. The up-regulated miR-376b-3p can reduce the proliferation and invasion of glioma cells, inhibit the formation of vasculogenic mimicry, and increase the expression of HOXD10, which is expected to inhibit the formation of two forms of angiogenesis at the same time. MiR-376b-3p may be a new therapeutic target of anti-angiogenesis for malignant glioma.

Polymorphisms rs763110 in FASL is linked to hepatitis C virus infection among high-risk populations

BACKGROUND

The Fas cell surface death receptor (FAS) and Fas ligand (FASL) can participate in the apoptosis of immune cells and target cells infected with a virus through the FAS-FASL signalling pathway. The decoy receptor 3 (DCR3) can competitively inhibit the binding of FAS to FASL. Our aim is to investigate the effect of single nucleotide polymorphisms (SNPs) in FAS, FASL and DCR3 on hepatitis C virus (HCV) infection.

METHODS

Four SNPs (rs763110 in FASL, rs1324551 and rs2234767 in FAS and rs2257440 in DCR3) were genotyped in 1495 controls free of HCV, 522 individuals with spontaneous HCV clearance and 732 patients with hepatitis C virus infection. The RegulomeDB database and RNAfold web servers were used to explore potential biological functions of SNPs.

RESULTS

FASL rs763110 was associated with susceptibility to HCV infection, and not to CHC. The odds ratio (95% confidence interval) of HCV infection in high-risk populations carrying FASL rs763110-TT was 1.82 (1.36-2.51, P < 0.001) compared to that of CC genotypes and 1.93 (1.43-2.60, P < 0.001) higher than that of CC + CT genotypes. Based on computer simulation, FASL rs763110-T may affect the transcription of mRNA by affecting the binding of a transcription factor, leading to structural changes in mRNA.

CONCLUSION

The genetic variant in FASL is linked with HCV infection, but not to spontaneous HCV clearance.

Older Adults' Perspective towards Participation in a Multicomponent Frailty Prevention Program: A Qualitative Study

OBJECTIVES

This study aimed to explore pre-frail and frail older Chinese people's perspectives on a multi-component, group-based frailty prevention program in Hong Kong, along with their views regarding factors determining participation and sustainability of such program.

DESIGN

Seven focus groups were conducted.

SETTING

Community elderly centres.

PARTICIPANTS

A total of 38 community-dwelling older people aged 54 - 84 (mean age, 64.9 years; female, 58%; married, 68%; retired, 97%) screened with pre-frailty or frailty completing a 12-week multi-component (involving physical, cognitive, and social activities), group-based frailty prevention program were interviewed.

MEASUREMENTS

Thematic analysis was conducted.

RESULTS

Using thematic analysis, perceived health benefits, peer support and social networking were identified as key motivators concerning intention to participate in the frailty prevention program; whereas perceived health benefits, socializing, sense of connectedness, expert guidance and sense of dignity were identified as key motivators concerning program adherence.

CONCLUSION

Majority of participants provided positive feedbacks about the multi-component intervention program in regards to their physical health, psychological well-being and social life. These findings highlighted several important factors for consideration in future design of frailty interventions regarding the needs of pre-frail and frail older adults, which could help to motivate and sustain their participation in community-based frailty prevention programs.