DEHP induces apoptosis and autophagy of the thyroid via Rap1 signaling pathway: In vivo and in vitro study

OBJECTIVE

DEHP has thyroid toxicity and affects thyroid function. However, the mechanism is unclear.

METHODS

The offspring of SD rats were gavaged with different doses of DEHP from in utero to 8 or 12 weeks old. We observed the thyroid morphology with HE and autophagosomes with TEM. The THs levels were tested with ELISA. The apoptosis level was tested by flow cytometry. The levels of apoptosis-related genes, autophagy-related genes and Rap1 pathway genes, were measured with qRT-PCR and Western blot. We established an MEHP-treated Nthy-ori 3-1 cell model and inhibited the Rap1 to verify the mechanism.

RESULTS

DEHP could cause pathological damage and ultrastructure damage of thyroids in offspring rats. After DEHP exposure, the THs levels were altered, the apoptosis levels increased, and autophagosomes appeared. DEHP significantly affected the levels of apoptosis-related genes and autophagy-related genes. DEHP also affected the levels of Rap1 pathway, which was correlated with the levels of apoptosis and autophagy. After inhibiting Rap1 in Nthy-ori 3-1 cells, the THs levels were altered. Rap1 pathway was inhibited and the levels of apoptosis and autophagy were down-regulated.

CONCLUSION

DEHP could induce the apoptosis and autophagy of the thyroid, and Rap1 signaling pathway may play a significant role.

Robotics Perception and Control: Key Technologies and Applications

The integration of advanced sensor technologies has significantly propelled the dynamic development of robotics, thus inaugurating a new era in automation and artificial intelligence. Given the rapid advancements in robotics technology, its core area-robot control technology-has attracted increasing attention. Notably, sensors and sensor fusion technologies, which are considered essential for enhancing robot control technologies, have been widely and successfully applied in the field of robotics. Therefore, the integration of sensors and sensor fusion techniques with robot control technologies, which enables adaptation to various tasks in new situations, is emerging as a promising approach. This review seeks to delineate how sensors and sensor fusion technologies are combined with robot control technologies. It presents nine types of sensors used in robot control, discusses representative control methods, and summarizes their applications across various domains. Finally, this survey discusses existing challenges and potential future directions.

Deteriorated bone microarchitecture caused by sympathetic overstimulation in pheochromocytoma and paraganglioma

PURPOSE

Despite the potentially destructive effect of sympathetic activity on bone metabolism, its impact on bone microarchitecture, a key determinant of bone quality, has not been thoroughly investigated. This study aims to evaluate the impact of sympathetic activity on bone microarchitecture and bone strength in patients with pheochromocytoma and paraganglioma (PPGL).

METHODS

A cross-sectional study was conducted in 38 PPGL patients (15 males and 23 females). Bone turnover markers serum procollagen type 1 N-terminal propeptide (P1NP) and β-carboxy-terminal crosslinked telopeptide of type 1 collagen (β-CTX) were measured. 24-h urinary adrenaline (24hUE) and 24-h urinary norepinephrine levels (24hUNE) were measured to indicate sympathetic activity. High-resolution peripheral quantitative computed tomography (HR-pQCT) was conducted to evaluate bone microarchitecture in PPGL patients and 76 age-, sex-matched healthy controls (30 males and 46 females). Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (DXA) simultaneously.

RESULTS

PPGL patients had a higher level of β-CTX. HR-pQCT assessment revealed that PPGL patients had notably thinner and more sparse trabecular bone (decreased trabecular number and thickness with increased trabecular separation), significantly decreased volume BMD (vBMD), and bone strength at both the radius and tibia compared with healthy controls. The deterioration of Tt.vBMD, Tb.Sp, and Tb.1/N.SD was more pronounced in postmenopausal patients compared with the premenopausal subjects. Moreover, subjects in the highest 24hUNE quartile (Q4) showed markedly lower Tb.N and higher Tb.Sp and Tb.1/N.SD at the tibia than those in the lowest quartile (Q1). Age-related bone loss was also exacerbated in PPGL patients to a certain extent.

CONCLUSIONS

PPGL patients had significantly deteriorated bone microarchitecture and strength, especially in the trabecular bone, with an increased bone resorption rate. Our findings provide clinical evidence that sympathetic overstimulation may serve as a secondary cause of osteoporosis, especially in subjects with increased sympathetic activity.

Strictureplasty may lead to increased preference in the surgical management of Crohn's disease: a case-matched study

BACKGROUND

Resection and strictureplasty are the two surgical modalities used in the management of Crohn's disease (CD). The objective of this study was to compare morbidity and clinical recurrence between patients who underwent strictureplasty and patients who underwent resection.

METHODS

Patients with CD who underwent strictureplasty between January 2012 and December 2022 were enrolled. The patients were well matched with patients who underwent resection without strictureplasty. Patient- and disease-specific characteristics, postoperative morbidity, and clinical recurrence were also analyzed.

RESULTS

A total of 118 patients who underwent a total of 192 strictureplasties were well matched to 118 patients who underwent resection. The strictureplasty group exhibited significantly less blood loss (30 ml versus 50 ml, p < 0.001) and stoma creation (2.5% versus 16.9%, p < 0.001). No significant difference was found regarding postoperative complications or length of postoperative stay. At the end of the follow-up, the overall rate of clinical recurrence was 39.4%, and no difference was observed between the two groups. Postoperative prophylactic use of biologics (odds ratio = 0.2, p < 0.001) was the only protective factor against recurrence.

CONCLUSION

Strictureplasty does not increase the risk of complications or recurrence compared with resection. It represents a viable alternative to resection in selected patients, and as such, it should have a broader scope of indications and greater acceptance among surgeons.

[Study on risk factors of mycobacterium tuberculosis infection among health workers in medical institutions]

Objective: To understand the infection status of mycobacterium tuberculosis among health workers in tuberculosis designated medical institutions and explore the risk factors of infection. Methods: From September 2021 to June 2022, a questionnaire survey was conducted among health workers in relevant departments of 4 tuberculosis designated medical institutions by cluster stratified sampling, including the implementation of hospital infection control measures in medical institutions and occupational exposure of medical staff to mycobacterium tuberculosis. Peripheral blood interferon gamma release assays (IGRAs) and lung imaging examination were performed to determine the mycobacterium tuberculosis infection. Factors with statistical significance in univariate analysis were included in multivariate logistic regression to analyze the risk factors of mycobacterium tuberculosis infection. Results: A total of 657 people completed the lung imaging examination and questionnaire, of which 654 people had peripheral blood IGRAs detection, and the latent infection rate of tuberculosis was 39.45% (258/654) . Univariate analysis showed that age, sex, marital status, economic income, occupational category, professional title, length of service, and other variables had statistical significances in tuberculosis latent infection (P<0.05) . In terms of personal health status, there were statistically significant differences in the distribution of health workers in terms of their tuberculosis history, tuberculosis history of their immediate family members, previous tuberculin skin test (TST) (P<0.05) . Multivariate analysis showed that there were four risk factors related to tuberculosis, including professional title (X(1)) , years of tuberculosis related works (X(2)) , tuberculosis history (X(3)) and previous TST (X(4)) . The regression equation of the probability of tuberculosis among health workers was y=-1.920+0.246X(1)+0.046X(2)+1.231X(3)+0.478X(4). Conclusion: The latent infection rate of tuberculosis among health workers in tuberculosis designated medical institutions is high. It is necessary to strengthen the management of infection control, carry out regular screening, enhance the self-protection awareness of health workers, and reduce their exposure to mycobacterium tuberculosis and infection risk.

Prediction of the mechanical properties of TPMS structures based on Back propagation neural network

Triply Periodic Minimal Surface (TPMS) has the characteristics of high porosity, a highly interconnected network, and a smooth surface, making it an ideal candidate for bone tissue engineering applications. However, due to the complex relationship between multiple parameters of the TPMS structure and mechanical properties, it is a challenging task to optimize the properties of TPMS structures with different parameters. In this study, a Back-Propagation Neural Network (BPNN) was utilized to construct the relationship between TPMS parameters. Its mechanical performance and the TPMS structure were optimized using the BPNN. Results indicated that after training the correlation coefficient (R) between the BPNN prediction and the experimental results is 0.955475, it shows that our BPNN model has an adequate accuracy in describing the TPMS structures properties. Result of TPMS structure optimization shows that after optimization the yield strength of Hybridized Gyroid-Diamond Structure (HGDS) is 6.20 MPa, which is increased by 102.61% when compared with the original Hybridized Gyroid-Diamond Structure (3.06 MPa). Result of topological morphology indicates the effective bearing area of the optimized model was increased by 12.92% compared with the original model, which ascribe the increase in yield strength of the optimization model.

Analysis of the Influencing Factors of Postoperative Constipation in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional and Prospective Study

BACKGROUND

The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery.

METHODS

This study included a cohort of 379 patients who underwent cardiovascular surgery at Nanjing Drum Tower Hospital. The patient cohort was stratified into two groups based on the presence or absence of postoperative constipation. Utilizing logistic regression analysis, both univariate and multivariate analyses were conducted to elucidate the factors influencing defecation problems. The predictive accuracy of the findings was subsequently evaluated through the receiver operating characteristic (ROC) curve.

RESULTS

Among the cohort of 379 patients subjected to cardiovascular surgery, a noteworthy 20.8% (n = 79) reported incidences of postoperative defecation issues. A multivariate logistic regression analysis showed that age (odds ratio (OR) = 1.063, 95% confidence interval (CI) 1.034-1.097, p < 0.001), operation time (OR = 1.004, 95% CI: 1.000-1.008, p = 0.028), ventilator usage time (OR = 1.032, 95% CI: 1.010-1.055, p = 0.004), polypharmacy (OR = 2.134, 95% CI: 1.069-4.321, p = 0.032), use of cough medicine (OR = 2.981, 95% CI: 1.271-6.942, p = 0.011) and psychological or behavioral barriers to defecation in the hospital environment (OR = 31.039, 95% CI: 14.313-73.179, p < 0.001) were independent risk factors for postoperative constipation in patients undergoing cardiovascular surgery. The area under the curve (AUC) for predicting postoperative constipation was 0.885.

CONCLUSION

In the pursuit of optimizing postoperative recovery and mitigating postoperative constipation incidence, a targeted approach is imperative. Specifically, a focused intervention directed towards elderly patients, extended operation and prolonged ventilator durations, polypharmacy regimens, use of cough medicine, and those with psychological or behavioral barriers to defecation within the hospital milieu emerges as pivotal.

The role of estrogen receptors (ERs)-Notch pathway in thyroid toxicity induced by Di-2-ethylhexyl phthalate (DEHP) exposure: Population data and in vitro studies

BACKGROUND

This study aimed to assess the exposure level and risk of Di-2-ethylhexyl Phthalate (DEHP) among adults in Jilin Province, China, clarify the impact of DEHP on human thyroid function, and to explore the role of estrogen receptors (ERs)-Notch signaling pathway in the effect of DEHP metabolites on thyroid hormones based on population data and in vitro experiments.

METHODS

312 adults participated in this study. Urinary DEHP metabolites were determined by high performance liquid chromatography coupled to a tandem mass spectrometer (HPLC-MS/MS). Two pharmacokinetic models were used to evaluate the estimated daily intake (EDI) and hazard quotient (HQ) of the adults. Multiple linear regression and mediating effect models were used to evaluate the target associations. In cell experiments, thyroid follicular epithelial (Nthy-ori3-1) cells were exposed to mono (2-ethylhexyl) phthalate (MEHP) for testing. The inhibitions of ERα and Notch pathway were conducted by siRNA and Notch pathway inhibitor DAPT.

RESULTS

The detection rate of five DEHP metabolites was 97.1∼100.0%. The HQ value of 0.3% of adults was higher than 1. The levels of urinary DEHP metabolites were significantly correlated with thyrotropin (TSH), thyrotropin-releasing hormone (TRH), total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3) and free thyroxine (FT4) and gene (estrogen receptor α (ERα), Notch1, Dll4) levels. The ERα-Notch pathway played a mediating role in the association between DEHP metabolite levels and FT4. The cell results showed, the levels of FT3 and FT4 in cell supernatant decreased after MEHP exposure, and the downward trend was reversed after ERα and notch pathways were inhibited, notch pathway genes also decreased after ERα inhibition.

CONCLUSION

Adults in the Jilin Province of China were widely exposed to DEHP. ERs-Notch pathway played an important role in the effect of DEHP metabolites on thyroid hormones.

Music prevents stress-induced depression and anxiety-like behavior in mice

Depression is the most prevalent psychiatric disorder worldwide and remains incurable; however, there is little research on its prevention. The leading cause of depression is stress, and music has been hypothesized to alleviate stress. To examine the potential beneficial effects of music on stress and depression, we subjected mice to chronic unpredictable mild stress (CUMS) during the day and music at night. Strikingly, our results indicated that music completely prevented CUMS-induced depression and anxiety-like behaviors in mice, as assessed by the open field, tail suspension, sucrose preference, novelty suppressed feeding, and elevated plus maze tests. We found that listening to music restored serum corticosterone levels in CUMS mice, which may contribute to the beneficial effects of music on the mouse brain, including the restoration of BDNF and Bcl-2 levels. Furthermore, listening to music prevented CUMS-induced oxidative stress in the serum, prefrontal cortex, and hippocampus of mice. Moreover, the CUMS-induced inflammatory responses in the prefrontal cortex and hippocampus of mice were prevented by listening to music. Taken together, we have demonstrated for the first time in mice experiments that listening to music prevents stress-induced depression and anxiety-like behaviors in mice. Music may restore hypothalamus-pituitary-adrenal axis homeostasis, preventing oxidative stress, inflammation, and neurotrophic factor deficits, which had led to the observed phenotypes in CUMS mice.

Prediction of Response to Neoadjuvant Chemoradiotherapy Combined with Pembrolizumab in Esophageal Squamous Cell Carcinoma with CT/FDG PET Radiomic Signatures Based on Machine Learning Classification

PURPOSE/OBJECTIVE(S)

PALACE-1 trial has confirm that the addition of pembrolizumab to neoadjuvant chemoradiotherapy (NCRT) improves the pathological complete response(pCR) for esophageal squamous cell carcinoma (ESCC), which might be a novel treatment strategy for ESCC. In the present study, we aim to establish a machine learning model to predict the local response to NCRT+ pembrolizumab for ESCC by using pretreatment 18-fluorodeoxyglucose positron emission tomography (FDG PET) and contrast-enhanced plan CT images.

MATERIALS/METHODS

A total of 65 cases treated with NCRT+ pembrolizumab followed by surgery were prospectively enrolled for analysis from 2019-2022. Each patient contains a contrast-enhanced plan CT and FDG PET images. 52 patients were randomly divided into training set and 13 patients were used as test set. The Extraction of radiomics features was performed using an open-source Python library PyRadiomics automatically. Features were computed according to the radiologist-drawn ROIs on both CT and PET images. In the feature selection stage least absolute shrinkage and selection operator (LASSO) was utilized on CT features and PET features separately. Four different machine learning models were implemented: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF) and XGBoost (XGB). The features selected by LASSO regression were used as model input and the output of the model is "pCR" or "non-pCR". To find the optimal parameter, the 5-fold cross-validation method was used in the training stage. In this study, we use accuracy, sensitivity and specificity as the metrics to evaluate the performance of the model on the testing cohort. The predictive performance of the model was assessed using the area under curve (AUC) of the receiver operating characteristics curve (ROC).

RESULTS

Of the 65 cases treated with NCRT+pembrolizumab, 35 patients archived pCR (53.8%), and 30 archived non-pCR. 1684 radiomics features were extracted from each case, and half of them (842 features) were from CT and others were from PET. Among the machine learning models mentioned above SVM achieves the most promising performance on the evaluation metrics. Accuracy, sensitivity, specificity and AUC score on test set were 0.692, 0.833, 0.571 and 0.786 for CT features and 0.615, 0.667, 0.571 and 0.762 for PET features, respectively. For CT+FDG PET fused features accuracy, sensitivity, specificity and AUC score on test set were 0.769, 0.667, 0.857 and 0.833.

CONCLUSION

In this study, we performed several different machine learning models to predict the response to NCRT+ pembrolizumab among ESCC based on the extracted radiomics features from CT and FDG PET images. The best-performing model based on radiomics features of CT and PET images could identify non-pCR to NCRT + pembrolizumab in EC patients.

Treatment Outcomes of Concurrent Nimotuzumab with Intensity Modulated Radiotherapy in Advanced Nasopharyngeal Carcinoma Patients Unfit for Concurrent Chemoradiotherapy: A Single Institute Experience

PURPOSE/OBJECTIVE(S)

To assess the safety and efficacy of intensity-modulated radiotherapy (IMRT) combined with nimotuzumab for patients with locally advanced nasopharyngeal carcinoma (LA-NPC) medically unfit to receive concomitant chemotherapy.

MATERIALS/METHODS

From 2016.6 to 2020.9, 34 newly diagnosed patients with local-regional advanced NPC medically unfit for concurrent chemoradiation had undergone definitive radiotherapy and were retrospectively evaluated. All patients were treated with IMRT combined treatment modality of nimotuzumab with or without cisplatin-based induction chemotherapy. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Acute and late radiation-related toxicities were evaluated based on the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 during and after IMRT. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate prognostic analyses were performed by using the Cox proportional hazard model.

RESULTS

The median follow-up time for the entire group was 15 months (range 5 to 55 months). At the time of this analysis, a total of 2 cases developed loco-regional recurrence. In addition, 4 patients developed distant metastasis. There was a total of 5 deaths: 3 patients died from distant metastasis, 1 patient died from the progression of loco-regional disease after recurrence, and the causes of death for the additional 1 case was a nasopharyngeal ulcer and deadly bleeding. The 1-year OS rate of the whole cohort was 87.9%, and the 1-year LFFR, DFFR, and PFS rates were 100%, 91.0%, and 91.0%, respectively. During the period of concurrent nimotuzumab and IMRT, no grade 3-4 hematologic toxicities and dermatitis were observed. Grade 3-4 radiotherapy-related oral mucositis was reported in 7 patients (20.6%). No infusion reaction was observed. No acneiform eruptions were found among these patients. The most commonly observed late complication was xerostomia. The degree of dry mouth in most patients was mild-to-moderate at the time of the last follow-up. Finally, 7 patients developed either unilateral or bilateral hearing impairment. One female patient experienced a nasopharyngeal ulcer and deadly bleeding after 5 months of completion of radiotherapy.

CONCLUSION

Concurrent nimotuzumab with IMRT for the treatment of LA-NPC was well tolerated, with encouraging survival data, and it could be an effective treatment alternative for patients with LA-NPC medically unfit for concomitant chemotherapy. Further clinical trials are needed to confirm these findings.

Development of a novel combined nomogram integrating deep-learning-assisted CT texture and clinical-radiological features to predict the invasiveness of clinical stage IA part-solid lung adenocarcinoma: a multicentre study

AIM

To develop a novel combined nomogram based on deep-learning-assisted computed tomography (CT) texture (DL-TA) and clinical-radiological features for the preoperative prediction of invasiveness in patients with clinical stage IA lung adenocarcinoma manifesting as part-solid nodules (PSNs).

MATERIALS AND METHODS

This study was conducted from January 2015 to October 2021 at three centres: 355 patients with 355 PSN lung adenocarcinomas who underwent surgical resection were included and classified into the training (n=222) and validation (n=133) cohorts. PSN segmentation on CT images was performed automatically with a commercial deep-learning algorithm, and CT texture features were extracted. The least absolute shrinkage and selection operator was used for feature selection and transformed into a DL-TA score. The combined nomogram that incorporated the DL-TA score and identified clinical-radiological features was developed for the prediction of pathological invasiveness of the PSNs and validated in terms of discrimination and calibration.

RESULTS

The present study generated a combined nomogram for predicting the invasiveness of PSNs that included age, consolidation-to-tumour ratio, smoking status, and DL-TA score, with a C-index of 0.851 (95% confidence interval: 0.826-0.877) for the training cohort and 0.854 (95% confidence interval: 0.817-0.891) for the validation cohort, indicating good discrimination. Furthermore, the model had a Brier score of 0.153 for the training cohort and 0.135 for the validation cohort, indicating good calibration.

CONCLUSION

The developed combined nomogram consisting of the DL-TA score and clinical-radiological features and has the potential to predict the individual risk for the invasiveness of stage IA PSN lung adenocarcinomas.

Establishing a Risk Stratification Model to Identify Clinically High-Risk N0 Breast Cancer Who Could Benefit from Regional Nodal Irradiation: A Single Institute Analysis

PURPOSE/OBJECTIVE(S)

The adverse clinical features for pN0 BC patients significantly varies and there is no established clinical risk stratification system to identify those "high-risk" pN0 BC patients who might benefit from RNI. The purpose of this real-world study was to investigate the risk factors for developing recurrence among patients with pathological T1-3N0 breast cancer (BC) treated with breast-conserving surgery (BCS) followed by whole breast irradiation alone (WBI) and identify those clinically high-risk BCs who could benefit from regional nodal irradiation (RNI).

MATERIALS/METHODS

Female BC patients treated from 2009 to 2016 were retrospectively reviewed. The disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method, and survival differences were compared with the log-rank test. Univariate and multivariate analysis was performed using Cox logistic regression analysis. An external validation was conducted by using SEER database.

RESULTS

A total of 622 BC patients treated with BCS+WBI alone were included. With a median follow-up of 82 months, the 7-year OS and DFS for the entire cohort was 97% and 91%, respectively. Multivariable Cox analysis indicated that tumor size (p = 0.006), tumor location (p = 0.033), lymphovascular invasion (LVI) status (p = 0.0028) and Ki-67 index (p = 0.051) were independent risk factors for DFS, while only tumor size was the only independent risk factors for OS (p = 0.029). A scoring system was developed using these four factors and the 7-year DFS and OS were 97% and 96% for patients with 0-1 risk factors, 95% and 82% for patients with ≥2 risk factors (p<0.0001 for DFS, and p = 0.0063 for OS). Based on tumor size and tumor location, an external validation by demonstrated that the 7-year OS was 90% and 88% for patients with 0-1 risk factor, which was significantly better than those defined as high-risk BC patients (82%, p<0.0001).

CONCLUSION

By using our institute database, we establish a risk stratification system for identifying sub-group of pN0 BC patients, who are at high risk for developing recurrence. The results of our study support tailored RT decision-making according to individual risks, which needed to be confirmed in further studies.

The Safety and Efficacy of SCART for Bulky Metastatic or Recurrent Cancer, a Phase I Study

PURPOSE/OBJECTIVE(S)

We are proposing a new treatment methodology, (called Stereotactic Centralized Ablative Radiation Therapy, (SCART), for bulky or metastatic tumors, which is based on the principles of SFRT, by using SBRT methods to deliver an ablative radiation dose to the central portion of the target while keeping the dose to surrounding normal tissue to a relatively low level. We performed a prospective dose escalation study of SCART for bulky metastatic or recurrent cancer. The purpose of the study was to determine dose-limiting toxicities (DLTs) and the Maximum Tolerated Dose (MTD) of SCART.

MATERIALS/METHODS

This study was registered at ClinicalTrials.gov Identifier: NCT0488198, and approved at Foshan Chancheng Hospital. Patients with unresectable solid "bulky" nonhematological malignancies with limited treatment options were enrolled and received SCART with a prescription to the central spot in the tumor with a peripheral dose to the tumor edge at around 20% isodose line of the prescription dose. Five dose levels were proposed. The primary endpoint was the maximum tolerated dose (MTD), defined as the highest dose where zero of three or one of six patients experienced grade 3 dose-limiting toxicity (DLT), scored according to the Common Toxicity Criteria for Adverse Events v. 4.03, up to 6 months after SCART.

RESULTS

A total of 21 patients received SCART and have eligible data for study follow-up. The dose was escalated for two patients to 24 GyX3. No grade 3 toxicity was observed in any of the enrolled patients. The median SCART dose was 18 Gy (range: 15 - 24). Six out of the 18 patients with data for overall survival (OS) died, and the median time to death was 16.29 months (range: 0.99 - 25.58). Three patients out of the 15 patients with available data for local recurrence (LR) were found to have an LR and the median time to LR was 16.01 months (range: 0.99 - 25.58). There appears to be a trend of tumors decreasing from the patient's first visit date, or pre-SCART, to their final volume post-SCART. The mean percent change for tumor shrinkage between first visit volumes and post-SCART volumes was 49.49% (SD: 40.89, p-value:0.009). Of 15 patients with available data for progression free survival, 9 had a local recurrence or were deceased. Estimated median survival (i.e., when survival is 50%) was equal to16.80 months (95% CI = 13.90, NA). The survival rate at 12 months and 24 months were72.22% and 24.07%, respectively. Of 15 patients with available data for time to local recurrence, 3 people had a local recurrence. The percent of patients that were free from local recurrence at one and two years after the beginning of SCART treatment was 85.56% for both.

CONCLUSION

Despite the high dose delivered and the excellent local control achieved; the incidence of Any toxicity was unexpectedly low. Multiple courses of SCART are possible. The optimal dose, volume and timing of SCART still need more study.

Nodal Response to Neo-Adjuvant Systemic Therapy Predicts Prognosis of cN3c Breast Cancer Patients Receiving Multidisciplinary Therapy

PURPOSE/OBJECTIVE(S)

cN3c breast cancer with ipsilateral supraclavicular (SCV) lymph nodal (SCLN) metastasis has a dismal prognosis. We investigated the survival outcomes, patterns and risks of recurrence in those patients after multidisciplinary therapy, as well as the predictors of candidates for SCV area boosting.

MATERIALS/METHODS

Consecutive cN3c breast cancer patients without distant metastases from January 2009 to December 2020 in our institution were retrospectively reviewed. Based on nodal response to neoadjuvant therapy (NAT), patients were categorized into three groups: clinical complete response (cCR) not achieved in SCLN (Group A, n = 66), SCLN cCR but axillary node (ALN) did not achieve pathological complete response (pCR, Group B, n = 34), cCR in SCLN and pCR in ALN (Group C, n = 13).

RESULTS

The median follow-up time was 32.7 months (range, 21.9-53.3months). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 64.6% and 43.7% respectively. Multivariate analysis showed cumulative SCV dose and ypT stage, ALN response and SCV response to NAT were significantly associated with OS and RFS respectively. The 3-year for patients receiving the cumulative SCV dose of ≥60 Gy versus <60 Gy was 81.3% versus 69.0% (P = 0.042). Compared with Group A or B, Group C showed significantly improved RFS (3y-RFS: 53.8% vs 73.6% vs 100%, p = 0.003) and a numerically longer OS (3y-OS: 73.4% vs 86.7% vs 100%, p = 0.089). Meanwhile, Group C showed the lowest rate of DM as first failure (37.9 % vs 23.5% vs 0 in group A, B and C, respectively, p = 0.010). In patients of Group A, the 3-year OS rates for patients receiving the cumulative SCV dose of ≥60 Gy versus <60 Gy was 78.0% versus 57.3% (p = 0.029).

CONCLUSION

Nodal response to NAT is an independent prognostic factor for survival and pattern of failure. cN3c breast cancer patients with SCLN cCR and ALN pCR after NAT are potentially curable. A cumulative SCV dose of ≥60 Gy is positively associated with improved OS, especially in patients of SCLN without achieving cCR. Our data supports the perspective of optimizing radiotherapeutic strategy based on nodal response.

High-Flux Neutron Generator Based on Laser-Driven Collisionless Shock Acceleration

A novel compact high-flux neutron generator with a pitcher-catcher configuration based on laser-driven collisionless shock acceleration (CSA) is proposed and experimentally verified. Different from those that previously relied on target normal sheath acceleration (TNSA), CSA in nature favors not only acceleration of deuterons (instead of hydrogen contaminants) but also increasing of the number of deuterons in the high-energy range, therefore having great advantages for production of high-flux neutron source. The proof-of-principle experiment has observed a typical CSA plateau feature from 2 to 6 MeV in deuteron energy spectrum and measured a forward neutron flux with yield 6.6×10^{7}  n/sr from the LiF catcher target, an order of magnitude higher than the compared TNSA case, where the laser intensity is 10^{19}  W/cm^{2}. Self-consistent simulations have reproduced the experimental results and predicted that a high-flux forward neutron source with yield up to 5×10^{10}  n/sr can be obtained when laser intensity increases to 10^{21}  W/cm^{2} under the same laser energy.

Effects of extrusion on physical properties of glutinous rice and its application in the improvement of quality characteristics of glutinous rice products

This study investigated the effects of extrusion on the physical properties of glutinous rice and addressed the challenges associated with its hardened texture and reduced taste in glutinous rice products by adding extruded glutinous rice to assess their anti-retrogradation effect compared with different improvers. Glutinous rice flour with different gelatinization degrees was obtained by changing the initial moisture content of glutinous rice grains before extrusion, and their physicochemical properties and the effect of adding them to rice products were analyzed. Results showed that with the increase in moisture content, the viscosity, water absorption index of extruded glutinous rice flour, and product viscosity increased, while the gelatinization degree, water solubility index, and product elasticity decreased, and the hardness of the rice products showed a trend of first decreasing and then increasing. Twenty percent moisture content of glutinous rice products showed the best properties mentioned above. The effects of adding different improvers on retrogradation degree, quality characteristics, microstructure, and moisture migration of glutinous rice products were analyzed by texture profile analysis, sensory evaluation, scanning electron microscopy, and low-field nuclear magnetic resonance. It was found that soybean polysaccharides, xanthan gum, and extruded glutinous rice flour had better anti-retrogradation effects, while colloid and soybean polysaccharides provided a tighter and more three-dimensional internal structure to the rice products. Our study showed that extruded glutinous rice flour had good anti-retrogradation properties and little effect on flavor and taste, but it would increase the roughness and viscosity of the products, which had advantages and disadvantages compared with other improvers.

Recent advancements in multimodal human-robot interaction

Robotics have advanced significantly over the years, and human-robot interaction (HRI) is now playing an important role in delivering the best user experience, cutting down on laborious tasks, and raising public acceptance of robots. New HRI approaches are necessary to promote the evolution of robots, with a more natural and flexible interaction manner clearly the most crucial. As a newly emerging approach to HRI, multimodal HRI is a method for individuals to communicate with a robot using various modalities, including voice, image, text, eye movement, and touch, as well as bio-signals like EEG and ECG. It is a broad field closely related to cognitive science, ergonomics, multimedia technology, and virtual reality, with numerous applications springing up each year. However, little research has been done to summarize the current development and future trend of HRI. To this end, this paper systematically reviews the state of the art of multimodal HRI on its applications by summing up the latest research articles relevant to this field. Moreover, the research development in terms of the input signal and the output signal is also covered in this manuscript.

[The design method of the digital sequential tooth-sectioning guide for the extraction of mandibular impacted third molars]

Objective: To explore a method for digitally designing and fabricating a sequential tooth-sectioning guide that can assist in the extraction of mandibular horizontal impacted third molars, preliminarily evaluate its feasibility and provide a reference for clinical application. Methods: Twenty patients with mandibular low level impacted third molars who visited the Department of General Dentistry, Peking University School and Hospital of Stomatology from March 2021 to January 2022 were selected. Cone-beam CT showed direct contact between the roots and mandibular canal, and full range impressions of the patients' intraoral teeth were taken and optical scans of the dental model were performed. The patients' cone-beam CT data and optical scan data were reconstructed in three dimensions, anatomical structure extraction, registration fusion, and the design of the structure of the guide (including crown-sectioning guide and root-sectioning guide) by Mimics 24.0, Geomagic Wrap 2021, and Magics 21.0 software, and then the titanium guide was three dimension printed, and the guide was tried on the dental model. After confirmation, the guide was used to assist the dentist in the operation. We observed whether the guide was in place, the number of tooth splitting, the matching of tooth splitting with the preoperative design, the operation time, and whether there were any complications. Results: In this study, 20 sectioning guides were successfully printed, all of them were well fitted in the patients' mouth, the average number of section was 3.4 times, the tooth parts was better matched with the preoperative design, and the average operative time of the guides was (29.2±9.8) minutes without complications such as perforation of the bone cortex. Conclusions: The use of sequential sectioning guides to assist in the extraction of mandibular impacted third molars was initially validated to accurately replicate the preoperative sectioning design, and is expected to provide a digital solution to improve surgical precision and ensure safety. Further studies with larger sample sizes are needed to evaluate its accuracy and safety.

An adaptive reinforcement learning-based multimodal data fusion framework for human-robot confrontation gaming

Playing games between humans and robots have become a widespread human-robot confrontation (HRC) application. Although many approaches were proposed to enhance the tracking accuracy by combining different information, the problems of the intelligence degree of the robot and the anti-interference ability of the motion capture system still need to be solved. In this paper, we present an adaptive reinforcement learning (RL) based multimodal data fusion (AdaRL-MDF) framework teaching the robot hand to play Rock-Paper-Scissors (RPS) game with humans. It includes an adaptive learning mechanism to update the ensemble classifier, an RL model providing intellectual wisdom to the robot, and a multimodal data fusion structure offering resistance to interference. The corresponding experiments prove the mentioned functions of the AdaRL-MDF model. The comparison accuracy and computational time show the high performance of the ensemble model by combining k-nearest neighbor (k-NN) and deep convolutional neural network (DCNN). In addition, the depth vision-based k-NN classifier obtains a 100% identification accuracy so that the predicted gestures can be regarded as the real value. The demonstration illustrates the real possibility of HRC application. The theory involved in this model provides the possibility of developing HRC intelligence.

JAK3/STAT5b/PPARγ Pathway Mediates the Association between Di(2-ethylhexyl) Phthalate Exposure and Lipid Metabolic Disorder in Chinese Adolescent Students

Our previous studies found that di (2-ethylhexyl) phthalate (DEHP) could disorder lipid metabolism in adolescents but the mechanisms underlying this association remained unclear. This study was undertaken to clarify the mediating effect of JAK3/STAT5/PPARγ on disorder lipid levels induced by DEHP in adolescents. We recruited 478 adolescent students (median age 18.1 years). The mRNA expression and DNA methylation levels of JAK3/STAT5/PPARγ were detected by real-time PCR and the MethylTarget, respectively. We used multiple linear regression to analyze the association between DEHP metabolites (MEHP, MEOHP, MEHHP, MECPP, MCMHP, and ΣDEHP) levels, mRNA expression, and DNA methylation levels. The mediating effect of JAK3/STAT5/PPARγ mRNA expression levels was examined by mediation analysis. We found that all DEHP metabolite levels were positively correlated with TC/HDL-C and LDL-C/HDL-C (P < 0.05). The MEOHP level was negatively associated with DNA methylation levels and positively associated with mRNA levels of PPARγ and STAT5b (P < 0.05). The MEHP level was negatively associated with the DNA methylation level and positively associated with the mRNA level of JAK3 (P < 0.05). Higher MEOHP was associated with a higher level of TC/HDL-C, the mediation analysis showed the mediation effect was 17.18% for the JAK3 level, 10.76% for the STAT5b level, and 11% for the PPARγ level. Higher MEHP was associated with a higher level of LDL-C/HDL-C, the mediation effect was 14.49% for the JAK3 level. In conclusion, DEHP metabolites decreased the DNA methylation levels, inducing the increase of the mRNA levels of JAK3/STAT5/PPARγ. In addition, the mRNA levels mediated the association between DEHP exposure and disorder lipid levels.

Sensor Fusion-Based Teleoperation Control of Anthropomorphic Robotic Arm

Sensor fusion is a technique that combines information from multiple sensors in order to improve the accuracy and reliability of the data being collected. In the context of teleoperation control of an anthropomorphic robotic arm, sensor fusion technology can be used to enhance the precise control of anthropomorphic robotic arms by combining data from multiple sensors, such as cameras, data gloves, force sensors, etc. By fusing and processing this sensing information, it can enable real-time control of anthropomorphic robotic arms and dexterous hands, replicating the motion of human manipulators. In this paper, we present a sensor fusion-based teleoperation control system for the anthropomorphic robotic arm and dexterous hand, which utilizes a filter to fuse data from multiple sensors in real-time. As such, the real-time perceived human arms motion posture information is analyzed and processed, and wireless communication is used to intelligently and flexibly control the anthropomorphic robotic arm and dexterous hand. Finally, the user is able to manage the anthropomorphic operation function in a stable and reliable manner. We also discussed the implementation and experimental evaluation of the system, showing that it is able to achieve improved performance and stability compared to traditional teleoperation control methods.

Analysis of the mechanism of Ricinus communis L. tolerance to Cd metal based on proteomics and metabolomics

The pollution of soil with heavy metals is an increasingly serious worldwide problem, and cadmium (Cd) has attracted attention because of its high toxicity to almost all plants. Since castor tolerates the accumulation of heavy metals, it has the potential for heavy metal soil remediation. We studied the mechanism of the tolerance of castor to Cd stress treatments at three doses: 300 mg/L, 700 mg/L, and 1,000 mg/L. This research provides new ideas for revealing the defense and detoxification mechanisms of Cd-stressed castor. By combining the results of physiology, differential proteomics and comparative metabolomics, we conducted a comprehensive analysis of the networks that regulate the response of castor to Cd stress. The physiological results mainly emphasize the super-sensitive responses of castor plant roots to Cd stress and the effects of Cd stress on plants' antioxidant system, ATP synthesis and ion homeostasis. We confirmed these results at the protein and metabolite levels. In addition, proteomics and metabolomics indicated that under Cd stress, the expressions of proteins involved in defense and detoxification, energy metabolism and other metabolites such as organic acids and flavonoids were significantly up-regulated. At the same time, proteomics and metabolomics also show that castor plants mainly block the root system's absorption of Cd2+ by enhancing the strength of the cell wall, and inducing programmed cell death in response to the three different doses of Cd stress. In addition, the plasma membrane ATPase encoding gene (RcHA4), which was significantly upregulated in our differential proteomics and RT-qPCR studies, was transgenically overexpressed in wild type Arabidopsis thaliana for functional verification. The results indicated that this gene plays an important role in improving plant Cd tolerance.

Quality assessment of pre- and postnatal nutrition and exercise mobile applications in the United States and China

Background

Mobile applications (apps) are becoming increasingly prevalent as tools for improving maternal health behaviors. However, the recently updated content and quality of these apps remain unknown. This research investigated the fundamental characteristics, functional modules, and overall quality of maternal apps available in the United States and China to reveal critical nutrition and physical activity gaps.

Methods

A systematic search was performed in Android and iOS app stores (China and the United States). Apps were eligible if they targeted pregnant or postpartum women, focused on nutrition or physical activity, and had interfaces in English or Chinese. The basic characteristics, functional modules, and overall quality of the apps were evaluated, and differences between apps available in China or the United States were determined using analysis of variance and chi-square tests. Pearson correlations were utilized to investigate links between objective quality and user rating.

Results

A total of 65 maternity-related nutrition and physical activity apps (34 from China and 31 from the United States) were eligible. Among them, 68% (21/31) of US apps and 56% (19/34) of Chinese apps did not provide supporting evidence for their content. A greater number of Chinese apps provided app-based general education modules, namely food nutrition knowledge (n = 0, 0% in the United States vs. n = 30, 88.2% in China). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 21, 67.7% in the United States vs. n = 2, 5.9% in China). The overall app quality rating in the United States was lower than it was in China (mean: 3.5, SD: 0.6 in China vs. mean: 3.4, SD: 0.7 in the United States). There was no relationship between the overall app quality rating and the user rating in either country (rho = 0.11 in China and rho = -0.13 in the United States).

Conclusion

The characteristics and functional modules of in-store apps for maternal nutrition and physical activity differed between the United States and China. Both countries' apps, especially Chinese apps, lacked evidence-based information, and there was no correlation between app quality and user rating. The results therefore suggest that user ratings cannot be used as an objective indicator of app quality and that it is necessary to improve the empirical basis and credibility of apps in both countries.

Metabolites identification and pharmacokinetic profile of hirsuteine, a bioactive component in Uncaria in rats by ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry

Hirsuteine is one of the major bioactive tetracyclic indole alkaloids found in Uncaria rhynchophylla (Miq.) Jacks, possessing a wide range of pharmacological activities including neuroprotective, anticonvulsant, antihypertensive, sedative and hypnotic, and so forth. The present study was undertaken to assess the metabolism and plasma pharmacokinetics of hirsuteine in rats. After oral administration of hirsuteine at the dose of 30 mg/kg, 13, 21, and 8 metabolites were detected in rat plasma, urine, and bile by ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry, respectively. Furthermore, plasma concentrations of hirsuteine and its four metabolites, 4-hirsuteine N-oxide, 3,4-dehydrohirsuteine, 11-hydroxyhirsuteine, and 11-hydroxyhirsuteine-11-O-glucuronide were simultaneously quantified in rat plasma, using carbamazepine as the internal standard. The linear calibration curve of hirsuteine was in the concentration range of 0.005-5.0 μg/ml. The lower limit of quantitation in the rat plasma was 5 ng/ml for hirsuteine. This study is the first to comprehensively investigate the metabolism process of hirsuteine and the pharmacokinetic profiles of hirsuteine and its major metabolite, and will provide a scientific basis to further elucidate the pharmacodynamic material basis and therapeutic mechanism of Uncaria prescriptions.

Role of estrogen receptors in thyroid toxicity induced by mono (2-ethylhexyl) phthalate via endoplasmic reticulum stress: An in vitro mechanistic investigation

Mono(2-ethylhexyl) phthalate (MEHP) can influence the expression of estrogen receptors (ERs) and induce thyroid injury. The expression of ERs can be related to thyroid disease and abnormal expression of ERs has been associated with activation of endoplasmic reticulum stress. This study aimed to clarify the role of ERs in MEHP-induced thyroid damage via endoplasmic reticulum stress. We exposed Nthy-ori 3-1 cells to different doses of MEHP. We found that after the exposure, the cell viability and the expression levels of thyroid hormone metabolism-related proteins decreased, while the apoptosis level and the expression levels of ERs (ERα and GPR30) increased. Three endoplasmic reticulum stress-related signaling pathways were activated by MEHP. After ERα and GPR30 were knocked down, these three pathways were inhibited and the thyroid toxicity was alleviated. Taken together, our results indicate that MEHP can induce thyroid toxicity by upregulating the expression of ERs, further activating endoplasmic reticulum stress.

Burnout and Mental Interventions among Youth Athletes: A Systematic Review and Meta-Analysis of the Studies

(1) Background: The subject of athlete burnout is often discussed among sports psychologists. Interventions to reduce this phenomenon are still under investigation with follow-ups. Thus, the purpose of the current meta-analysis is to examine psychological interventions that was carried out to decrease or eliminate burnout syndrome in young athletes. (2) Methods: Scientific electronic databases were searched, and five published studies published between January and June 2022 that met the criteria were selected. The systematic review and meta-analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Cochrane collaboration tool for assessing the risk of bias was used to assess the studies' quality. Metafor, a package of the R statistical program, was used to perform the analysis. (3) Results: Cognitive behavioral therapy- and mindfulness-based interventions effectively reduced most dimensions of burnout. Moreover, online interventions were significantly more beneficial in this reduction. (4) Conclusions: There should be more high-quality studies on the effectiveness of psychological interventions in reducing burnout, mainly because it leads to tremendous physical and psychological problems for athletes and their coaches; therefore, it requires particular interventions and prevention strategies.

Urinary excretion of silibinin diastereoisomers and their conjugated metabolites in rat and human at different dosages

Silibinin is a mixture of two flavonoid lignan silibinins A and B from the seeds of milk thistle (Silybum marianum L.). Using UPLC/Q-TOFMS, a total of 18 metabolites were identified in rat and human urine samples after oral administration of Silibinin Capsule. Furthermore, nine glucuronides and/or sulfated metabolites and two prototype compounds were simultaneously quantified in rat urine after oral administration of Silibinin Capsule at 50 and 100 mg/kg. Over a 72-h period, 27.6% and 23.3% of the silibinin were excreted in the forms of eleven metabolites in urine, among which, 5 major metabolites, including silibinin A-7-O-β-glucuronide (SA-7G), silibinin B-7-O-β-glucuronide (SB-7G), silibinin A-5-O-β-glucuronide (SA-5G), silibinin B-5-O-β-glucuronide (SB-5G) and silibinin A-20-O-glucuronide (SA-20G), accounted for 20.5% and 15.5% of the dosages separatively at doses of 50 and 100 mg/kg. These results suggested that glucuronidation at the C7-, C5- and C20- hydroxyls was the primary metabolic pathway of silibinin diastereoisomers in vivo. The present results provide helpful information for in vivo metabolism and clinical usage of Silibinin Capsule.

The Influence Mechanism of Vegetation Type on the Characteristics of nirS-Type Denitrifying Microbial Communities in Qinghai Lake Wetlands

Soil denitrification is an important process in the emission of N₂O, an atmospheric greenhouse gas. Environmental factors of different vegetation types are largely heterogeneous, which may directly or indirectly affect N₂O fluxes. Through high-throughput sequencing of the nitrite reductase gene nirS, this study investigated the influence of vegetation type on the structure and diversity of denitrifying microbial communities in Qinghai Lake wetlands, China. The results showed that among the four vegetation types in the Qinghai Lake wetlands, Carex rigescens (CR) had the highest species richness index, and Leymus secalinus (LS) had the lowest species richness index. Species evenness followed the opposite trend. Proteobacteria were the main denitrifying bacterial phylum in the wetland soil of Qinghai Lake. There were 40 differential bacterial flora at different levels in the four vegetation types, most of which belonged to Proteobacteria. Magnetospirillum is a bacterium that differed significantly across the four vegetation types, and it was one of the main denitrifying taxa based on relative abundance in the LS vegetation type. Soil pH was the most important regulating factor of nirS-type denitrifying microbial community in Qinghai Lake wetland. In summary, the succession of vegetation types in the Qinghai Lake Wetlands changes the soil microenvironment and significantly affects the community structure and diversity of the denitrifying microbial communities. The large-area growth of CR might even increase the emission of nitrous oxide. This study can serve as a reference for further exploration of the N₂O emission mechanism in the unique habitats of alpine wetlands.

POS0749 ANTI-Β2GPI-DOMAIN 1 ANTIBODIES STRATIFY HIGH RISK OF EXTRA-CRITERIA MANIFESTATIONS IN A LARGE PROSPECTIVE CHINESE COHORT OF ANTIPHOSPHOLIPID SYNDROME

Background

Anti-β2GPI-Domain 1 (β2GPI-D1) antibodies are potentially pathogenic in patients with antiphospholipid syndrome (APS), but their clinical associations and diagnostic value were unclear.

Objectives

To evaluate the clinical characteristics of APS patients with anti-β2GPI-D1 positivity, and its utility in diagnosing APS among SLE patients.

Methods

A total of 338 patients were included, of which 169 patients diagnosed with primary APS (PAPS group), 50 with APS secondary to SLE (SAPS group), 209 with SLE (SLE group). Serum anti-β2GPI-D1 IgG was measured using chemiluminescent immunoassay (Inova Company). Extra-criteria manifestations were analyzed, including thrombocytopenia, autoimmune hemolytic anemia, valvular lesions, APS nephropathy, and non-vascular neurological manifestations.

Results

Similar presence of anti-β2GPI-D1 IgG was seen among PAPS (32.80%) and SAPS (32.0%) patients, and 96.4% of those with positive anti-β2GPI-D1 IgG showed triple aPLs positivity. Anti-β2GPI-D1 IgG was significantly associated with recurrent thrombosis before APS diagnosis, microscopic thrombosis (p<0.05), but not with adverse pregnancy events (Figure 1). Notably, patients with extra-criteria manifestations, especially thrombocytopenia and APS nephropathy, showed significantly higher titers in anti-β2GPI-D1 IgG (p<0.05). After a median follow-up of twenty-five months, patients with anti-β2GPI-D1 IgG also showed a tendency of more extra-criteria events (3/55 vs 1/114, p=0.095), but not thrombotic events or adverse pregnancy events. Anti-β2GPI-D1 was positive among 8.13% of the SLE controls, and showed higher specificity (91.9%) in diagnosing SAPS among SLE patients as compared to classic aPLs.

Figure 1.

Conclusion

Anti-β2GPI-D1 IgG had a stronger association with extra-criteria manifestations in APS patients compared to three classic APLs, which properly indicated its pathogenic role of microangiopathy.

Disclosure of Interests

None declared

OP0145 VALIDATION OF 3 PREDICTION MODELS FOR THROMBOSIS IN ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON A PROSPECTIVE COHORT

Background

Antiphospholipid syndrome (APS) is a rare and complicated acquired autoimmune thrombophilia characterized by arterial/venous thrombosis and/or recurrent pregnancy loss. Thrombosis is the first cause of death of APS patients. However, there has been no generally acknowledged model to predict thrombosis. Only adjusted global APS score (aGAPSS) was developed for prediction but based on a cross-sectional study1. Additionally, the predictive ability of Padua score and Caprini score has not been validated in APS patients.

Objectives

Aim to validate the ability of aGAPSS, Padua score and Caprini score to predict thrombosis in APS patients basing on a prospective cohort.

Methods

Consecutive APS patients who fulfilled the 2006 Sydney Revised Classification Criteria for APS, referred to Peking Union Medical College Hospital were included. Clinical data, aGAPSS, Padua score, and Caprini score at the time of diagnosis were collected. Patients with less than 1-year follow-up were excluded. Harrell c-index and calibration curve were used to validate the prediction models.

Results

A total of 302 patients were enrolled in this study. The mean age was 32±12 years old, and 202 (66.9%) were female (Table 1). Patients were followed up for a median of 36 months. During the follow-up period, there were 62 thrombotic events, with 40 (13.25%) venous and 22 (7.28%) arterial thrombosis. The 1-, 3-, and 5-year thrombosis risks were 8.9%, 16.9%, and 21.3% respectively (Figure 1A). The Harrell c-indexes for predicting thrombosis of aGAPSS, Padua score, and Caprini score were 0.56 (95% confidence interval [CI], 0.52-0.60), 0.58 (95% CI, 0.54-0.62), and 0.61 (95%CI, 0.57-0.65) respectively. The model predicting venous thrombosis with the best discrimination was Padua score whose Harrell c-index was 0.64 (95% CI, 0.60-0.68), and the model predicting arterial thrombosis with the best discrimination was Caprini score whose Harrell c-index was 0.62 (95%CI, 0.56-0.68). The calibration curves illustrated that the calibration for predicting thrombosis within 3 years after diagnosis of all the 3 models was poor (Figure 1B-D).

Table 1.

Demographic characteristics and clinical manifestations at baseline

N=302N=302Age, mean±SD32±12Clinical manifestationsFemale, n (%)202 (66.9)Venous thrombosis, n (%)156 (51.7)Disease duration (months), median (Q1, Q3)11.50 (3.00, 44.00)Deep venous thrombosis, n (%)112 (37.1)Secondary to SLE, n (%)73 (24.2)Pulmonary embolism, n (%)70 (23.2)Smoking history, n (%)63 (20.9)Visceral venous thrombosis, n (%)12 (4.0)Hypertension, n (%)59 (19.5)Cranial venous sinus thrombosis, n (%)13 (4.3)Hyperlipidemia, n (%)151 (50.0)Arterial thrombosis, n (%)113 (37.4)BMI, mean±SD23.96±3.89Stroke/TIA, n (%)62 (20.5)LA positive, n (%)241 (79.8)Myocardial infarction, n (%)14 (4.6)aCL positive, n (%)208 (68.9)Arterial thrombosis of lower extremities, n (%)22 (7.3)aβ2GPI positive, n (%)242 (80.1)Visceral arterial thrombosis, n (%)18 (6.0)Triple aPL positive, n (%)165 (54.6)Thrombocytopenia, n (%)118 (39.1)Obstetric manifestations, n (%)N=202Valvular lesions, n (%)24 (7.9)Pregnancy morbidity103 (51.0)Early miscarriages (<10 weeks)13 (6.4)Fetal death (>= 10 weeks)68 (33.7)Preeclampsia, eclampsia and placental dysfunction36 (17.8)Figure 1.

The Kaplan-Meier curve and the calibration curve of 3 prediction models within 3 years after diagnosis. A: The Kaplan-Meier curve of venous, arterial and both venous and arterial thrombosis. B: The calibration curves for venous thrombosis. C: The calibration curves for arterial thrombosis. D: The calibration curves for both venous and arterial thrombosis.

Conclusion

The ability of aGAPSS, Padua score and Caprini score to predict thrombosis in APS patients is relatively poor. Construction of a new prediction model specifically for APS patients is required to help with early prevention and treatment.

References

[1]Sciascia, S., et al., GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford), 2013. 52(8): p. 1397-403.

Disclosure of Interests

None declared

Adverse effects of PM2.5 on cardiovascular diseases

As an air pollutant, fine particulate matter with a diameter  ≤ 2.5 μm (PM_2.5) can enter the body through the respiratory tract and cause adverse cardiovascular effects. Here, the effects of PM_2.5 on atherosclerosis, hypertension, arrhythmia, myocardial infarction are summarized from the perspective researches of human epidemiology, animal, cell and molecule. The results of this review should be proved useful as a scientific basis for the prevention and treatment of cardiovascular disease caused by PM_2.5.

The associations of urinary DEHP metabolite levels, serum thyroid hormones, and thyroid-related genes among the adolescent students from China: a cross-sectional study

Our study aimed to investigate the associations between DEHP exposure and serum thyroid hormone levels in 347 adolescents and young adults. We measured DEHP metabolites including mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), and mono(2-carboxymethyl)hexyl phthalate (MCMHP) in their urine. Total thyroxine (TT4), total triiodothyronine, free triiodothyronine, free thyroxine (FT4), thyroid-stimulating hormone and the mRNA levels of thyroid peroxidase (TPO), thyroglobulin (TG), sodium iodide symporter (NIS), thyroid transcription factor 1 (TTF-1), and paired box gene 8 (PAX-8) in serum were measured. The results of statistical analysis showed that urinary DEHP metabolites were generally negatively associated with TT4 levels in serum. In the males, the FT4 levels showed positive associations with urinary MEHP, MECPP, MCMHP, and ∑DEHP. The mRNA level of TG was significantly positively correlated with the levels of MECPP, MCMHP, and ∑DEHP, while the levels of TTF-1 and PAX-8 mRNA were significantly positively correlated with the levels of DEHP metabolites. Taken together, DEHP may affect the synthesis of TG by altering the normal transcription of TTF-1 and PAX-8, leading to decreased TT4 levels in Chinese adolescents.

Exploring the relationship between systemic lupus erythematosus and osteoporosis based on bioinformatics

OBJECTIVE

This study aimed to explore the relationship between systemic lupus erythematosus (SLE) and osteoporosis (OP) based on bioinformatics.

METHODS

The expression profiles of SLE and OP gene chips were searched through the GEO database, and the differentially expressed genes (DEGs) were screened out to obtain the intersection. Then, the Funrich software was used to predict the upstream miRNAs of the intersection genes, and the miRNA-mRNA relationship network was constructed. Afterward, the String database and Cytoscape software were used to construct the protein interaction network of the intersection genes to screen out the key genes. Finally, the functions and related pathways of key genes were analyzed by using the DAVID database.

RESULTS

①A total of 140 intersection genes of SLE and OP were obtained; ②There were 217 miRNAs regulating the intersection genes; ③IL-4, FOS, TLR1, TLR6, CD40LG, CCR1 were the key genes in the protein interaction network; ④The DAVID enrichment analysis mainly covered the positive regulation of cytokine production, the regulation of osteoclast differentiation, macrophage activation and other biological processes, involving Toll-like receptor signaling pathway, T cell receptor signaling pathway, Th1, Th2, and Th17 cells Differentiation, IL-17 signaling pathway.

CONCLUSIONS

SLE and OP still have some highly overlapping differential gene expressions under the background of complex gene networks. The gene functions and signaling pathways involved can simultaneously regulate the two diseases, suggesting that there is a close relationship between the molecular mechanisms of the two diseases, and that it may be a target of drugs that interfere with two diseases at the same time.

Di(2-ethylhexyl) phthalate (DEHP) and thyroid: biological mechanisms of interference and possible clinical implications

Di(2-ethylhexyl) phthalate (DEHP) is a ubiquitous environmental endocrine disruptor. DEHP can be absorbed into the human body through the air, food, water, and skin. After entering the human body, DEHP is rapidly converted to mono(2-ethylhexyl) phthalate (MEHP) with greater toxicity than DEHP. An increasing number of studies indicates that DEHP or MEHP can damage the thyroid tissue and disrupt the function, but the mechanisms remain unclear. This article reviews the toxicity of DEHP on thyroid structures and functions and summarizes the potential mechanisms to provide evidence for preventing the thyroid-related diseases.

Epilepsy Combined With Multiple Gene Heterozygous Mutation

The fast pace of gene discovery has resulted in groundbreaking advances in the field of epilepsy genetics. Clinical testing using comprehensive gene panels, exomes, or genomes is now increasingly available and has significantly increased the diagnostic yield for early-onset epilepsies and enabled precision medicine approaches. In this paper, we report a case of epilepsy in a pedigree. The proband had heterozygous mutations in KCNC1 (NM_001112741.1:c.959G>A, p. Arg320His), CAPN3 (NM_000070.2:c.526G>A, p. Val176Met), and NEFH (NM_021076.3:c. 2595 delC, p. Lys866Argfs^*51). Sanger sequencing verification was consistent with the results of whole-exome sequencing. The KCNC1 mutation was a de novo mutation, and the CAPN3 and NEFH mutations were inherited from their father and mother, respectively. Based on the American College of Medical Genetics and Genomics (ACMG) guidelines, a heterozygous mutation was found for APOB (NM_000384.2: c.10579C > T, p. Arg3527Trp). The heterozygous mutation at this site was inherent in the pedigree. Coexpression analysis indicated that heterozygous mutations of KCNC1, CAPN3, NEFH, and APOB were closely related to the clinical phenotypes of the patient, and the clinical phenotypic heterogeneity of the disease may be the result of the interaction of multiple genes.

CT texture analysis-based nomogram for the preoperative prediction of visceral pleural invasion in cT1N0M0 lung adenocarcinoma: an external validation cohort study

AIM

To develop a nomogram based on computed tomography (CT) texture analysis for the preoperative prediction of visceral pleural invasion in patients with cT1N0M0 lung adenocarcinoma.

MATERIALS AND METHODS

A dataset of chest CT containing lung nodules was collected from two institutions, and all surgically resected nodules were classified pathologically based on the presence of visceral pleural invasion. Each nodule on the CT image was segmented automatically by artificial-intelligence software and its CT texture features were extracted. The dataset was divided into training and external validation cohorts according to the institution, and a nomogram for predicting visceral pleural invasion was developed and validated.

RESULTS

Of a total of 313 patients enrolled from two independent institutions, 63 were diagnosed with visceral pleural invasion. Three-dimensional (3D) CT long diameter, skewness, and sphericity, and chronic obstructive pulmonary disease were identified as independent predictors for visceral pleural invasion by multivariable logistic regression. The nomogram based on multivariable logistic regression showed great discriminative ability, as indicated by a C-index of 0.890 (95% confidence interval [CI]: 0.867-0.914) and 0.864 (95% CI: 0.817-0.911) for the training and external validation cohorts, respectively. Additionally, calibration of the nomogram revealed good predictive ability, as indicated by the Brier score (0.108 and 0.100 for the training and external validation cohorts, respectively).

CONCLUSIONS

A nomogram was developed that could compute the probability of visceral pleural invasion in patients with cT1N0M0 lung adenocarcinoma with good calibration and discrimination. The nomogram has potential as a reliable tool for clinical evaluation and decision-making.

Mechanisms of cardiovascular toxicity induced by PM2.5: a review

An increasing number of studies have shown that exposure to particulate matter with a diameter ≤ 2.5 μm (PM_2.5) could affect the onset and development of cardiovascular diseases. To explore the underlying mechanisms, the studies conducted in vitro investigations using different cell lines. In this review, we examined recently published reports cited by PubMed or Web of Science on the topic of cardiovascular toxicity induced by PM_2.5 that carried the term in vitro. Here, we summarized the suggested mechanisms of PM_2.5 leading to adverse effects and cardiovascular toxicity including oxidative stress; the increase of vascular endothelial permeability; the injury of vasomotor function and vascular reparative capacity in vascular endothelial cell lines; macrophage polarization and apoptosis in macrophage cell lines; and hypermethylation and apoptosis in the AC16 cell line and the related signaling pathways, which provided a new research direction of cardiovascular toxicity of PM_2.5.

[The predictive value of ureteral wall area for impacted ureteral stones]

Objective: To investigate the clinical indicators for preoperative prediction of impacted ureteral stones and analyze the predictive value of ureteral wall area(UWA). Methods: A total of 197 patients who underwent ureteroscopic lithotripsy due to ureteral stones at our institution from January to December 2020 were retrospectively analyzed. Preoperative patient age, gender, body mass index (BMI), history of hypertension, diabetes mellitus, side of stone, location of stone, maximum diameter of stone, CT value of stone, C-reactive protein (CRP), creatinine, renal pelvis diameter, ureteral wall thickness and UWA were collected. Patients were divided into impacted and non-impacted groups according to whether the stones were impacted intraoperatively. Univariate analysis was used to compare the differences in each clinical indicator between the two groups, and multivariate logistic regression was performed to analyze the independent predictors of impacted stones for those with differences. The receiver operating characteristic (ROC) curve was used to analyze the predictive power of each independent predictor, and the Delong test was used to analyze whether the difference in the area under the curve (AUC) of each independent predictor was statistically significant. Results: All 197 patients successfully completed the operation, aged 51 (36, 56) years; 137 males and 60 females. According to the results of ureteroscopy, they were divided into 82 cases of impacted ureteral stones and 115 cases of non-impacted ureteral stones. Univariate analysis showed that there were significant differences in maximum stone diameter, stone CT value, renal pelvis diameter, ureteral wall thickness and ureteral wall area between the two groups (P<0.05); There was no significant difference in age, gender, BMI, history of hypertension, diabetes, stone side, location of stone, CRP and creatinine (P>0.05). Multivariate logistic regression analysis showed that stone CT value (P<0.01), ureteral wall thickness (P<0.001) and ureteral wall area were independent predictors of impacted ureteral stones (P<0.001). The ROC curve was used to compare the predictive efficacy of independent predictors of stone CT value, ureteral wall thickness and ureteral wall area. The area under the ureteral wall area curve was the largest (AUC = 0.901, 95%CI: 0.859-0.943, P<0.001), followed by ureteral wall thickness (AUC = 0.799, 95%CI: 0.736-0.862, P<0.001) and stone CT value (AUC = 0.700, 95%CI: 0.626-0.775, P<0.001). By Delong test, there were significant differences in AUC between ureteral wall area and stone CT value (Z=4.527, P<0.001) and ureteral wall thickness (Z=3.407, P<0.001). The best predictive value of ureteral wall area was 79.6 mm². The sensitivity and specificity of this critical value for predicting ureteral incarcerated calculi were 80.1% and 89.5%. Conclusions: The UWA, ureteral wall thickness as well as the CT value of stones were all independent predictors of impacted ureteral stones, and UWA had a better predictive value.

Role of miR-145-5p/ CD40 in the inflammation and apoptosis of HUVECs induced by PM2.5

Fine particulate matter (PM_2.5) exposure can cause the injury of vascular endothelial cells by inflammatory response. CD40 works in inflammation of endothelial cells and it may be regulated by the miRNAs. This study aimed to clarify the role and mechanism of CD40 and miR-145-5p in PM_2.5-induced injury of human umbilical vein endothelial cells (HUVECs). HUVECs were treated with different concentrations of PM_2.5 exposure (0, 100, 200, 400 μg/mL) for 24 h. The si-RNA was used for CD40 gene silencing (0, 200 μg/mL PM_2.5, siRNA-CD40 and siRNA-CD40 + 200 μg/mL PM_2.5). Mimics was used for overexpression of miR-145-5p (0, 200 μg/mL PM_2.5, mimics and mimics+200 μg/mL PM_2.5). The cell viability of HUVECs was detected with Cell Counting Kit8 (CCK8) kit. The level of cell apoptosis was detected by flow cytometry. The inflammation-related factor including interleukin-1β (IL-1β), interleukin-18 (IL-18), tumor necrosis factor α (TNF-α) and C1q complement/tumor necrosis factor (TNF)-associated proteins9 (CTRP9) were tested with enzyme-linked immunosorbent assay (ELISA) kits. The mRNA and protein expression levels of CD40, CD40L, caspase1, NLRP3 (Nod-like receptor family pyrin domain-containing 3) and IKKB were detected with quantitative real-time PCR (qRT-PCR), Western blot and Immunofluorescence. Compared with the control group, the cell viability of HUVECs exposed to PM_2.5 was significantly decreased (p < 0.05); the levels of IL-Iβ and TNF-α were significantly increased, while the level of CTRP9 was significantly decreased (p < 0.05). The proportion of apoptotic cells was increased after being treated with PM_2.5 (p < 0.05). Besides, the mRNA and protein levels of CD40, CD40L, IKKB, NLRP3 and caspase1 were increased comparing with the control group (p < 0.05). After CD40 silencing, the condition of inflammation and apoptosis in HUVECs exposed to PM_2.5 was alleviated, and the expression levels of CD40L, IKKB, NLRP3 and caspase1 were significantly decreased (p < 0.05). Furthermore, miR-145-5p was significantly down-regulated after exposure to 200μg/mL PM_2.5 (p < 0.05). After over-expression of miR-145-5p, the expression level of CD40 was decreased (p < 0.05). Taken together, PM_2.5 can cause inflammation and apoptosis of HUVECs via the activation of CD40, which can be regulated by miR-145-5p. Over-expression of miR-145-5p can down-regulate CD40, further inhibiting the inflammation and apoptosis of HUVECs induced by PM_2.5.

Relationships between di-(2-ethylhexyl) phthalate exposure and lipid metabolism in adolescents: Human data and experimental rat model analyses

In recent years, the incidence of lipid metabolism disorders in adolescents has gradually increased, and the effects of DEHP on lipid metabolism have received widespread attention. In this study, 463 adolescents aged 16-19 years were enrolled as subjects. This study analyzed the associations between the urinary levels of DEHP metabolites (MEHP, MEOHP, MEHHP, MECPP, MCMHP, and ∑DEHP) and BMI, WHR, WtHR, VAI, LAP, the plasma levels of lipids (TC, TG, HDL-C, and LDL-C), and the peripheral blood leukocyte mRNA levels of SREBP-2, SR-BI, LDLR, and NR1H3. Animal experiments were performed to confirm and expand findings. Wistar rats were administered DEHP at 0, 5, 50, and 500 mg/kg/d for 8 weeks. The serum and liver levels of TC, TG, HDL-C, and LDL-C, and the liver mRNA and protein levels of SREBP-2, SR-BI, LDLR, and NR1H3 were measured. The results showed that WHR, VAI, and LAP were significantly positively associated with the urinary levels of MECPP and ∑DEHP; the plasma HDL-C level was significantly negatively associated with the levels of MECPP, MCMHP and ∑DEHP; the peripheral blood leukocyte mRNA levels of SREBP-2, NR1H3, and LDLR were significantly positively correlated with the MCMHP level; and the SR-BI mRNA level was significantly positively correlated with the levels of MECPP and MCMHP in adolescents. Moreover, the results of animal experiments showed that DEHP exposure significantly increased the serum levels of TC, HDL-C, and LDL-C in 500 mg/kg/d group, as well as the liver levels of TC and HDL-C, up-regulated SREBP-2 mRNA and protein expression in 50 and 500 mg/kg/d groups. DEHP exposure significantly down-regulated SR-BI and NR1H3 protein expression in the liver of the 500 mg/kg/d group rats. Our findings indicate that DEHP exposure can affect lipid metabolism in adolescents by regulating the expression of lipid metabolism-related genes.

Role of Notch pathway in effect of mono-2-ethylhexyl phthalate on the proliferation and cell cycle of SH-SY5Y cell

Neuroblastoma (NB) is an estrogen-dependent tumor. Mono-2-ethylhexyl phthalate (MEHP) has an estrogen-like effect. However, the effects of MEHP on the progression of NB are not well illustrated. This study was to clarify the effect of Notch pathway on proliferation and cell cycle of SH-SY5Y cell induced by MEHP. The viability of SH-SY5Y and BE2C cells were detected by CCK8; cell cycle and apoptosis were detected by flow cytometry; the protein expression levels of Notch pathway and cell cycle related proteins were detected by Western-blot. Results show that MEHP exposure can promote cell proliferation and altered the cell cycle. MEHP exposure can up-regulate the expression of C-MYC, Cyclin D1, Bcl-2 and affected the Notch pathway. In conclusion, MEHP exposure can promote NB cell proliferation and affect the cell cycle and apoptosis. Notch pathway plays a critical role in accelerating the cell cycle and inhibiting the apoptosis of SH-SY5Y cells caused by MEHP.

The Pygmalion Effect to Piano Teaching From the Perspective of Educational Psychology

Aiming at the problem of low student enthusiasm in piano teaching, this work tried to apply “Pygmalion effect” to piano teaching from the perspective of educational psychology. Forty-five students were chosen from nine classes in grades 2, 4, and 6 of a central elementary school in Beijing City using experimental research, and the experimental group and the control group were set up. A questionnaire was adopted to conduct the pre-test and post-test of the experiment, which were done to analyze the factors that affect the attitude of students toward music learning and the effect of piano teaching. The results show that the encouragement level of the piano teacher and the enthusiasm of the students in the piano course were significantly correlated at the 0.01 level. There was also a significant correlation between self-efficacy and student piano learning enthusiasm at the 0.01 level. Furthermore, the pre-test and post-test results showed that the students in the experimental group of each grade generally performed much better in piano learning than the students in the control group, which proves that the “Pygmalion effect” can play an excellent interventional role in piano teaching. In this research, the value of “Pygmalion effect” in the educational psychology of piano music education in primary schools was deeply studied to explore the possibility of a novel piano teaching model. The research results show that teacher encouragement can stimulate the subjective initiative of students and make them perform better in piano learning. This research provides reference and ideas for the combination of education- and psychology-related research in the music classroom.

OP0290 CLINICAL CHARACTERISTICS AND PROGNOSIS OF ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON CLUSTER ANALYSIS: A 10-YEAR COHORT STUDY

Background:

APS is an autoimmune disease characterized by persistent antiphospholipid antibodies (aPLs) positivity, leading to thrombotic events or pregnancy morbidity. High-risk aPLs profiles included positive lupus anticoagulant (LA) and multiple aPLs positivity1. Association was also found between aPLs and a variety of manifestations beyond thrombosis, referred to “non-criteria manifestations” (i.e. thrombocytopenia, hemolytic anemia, heart valve disease and aPL-related nephropathy)2, of which the role in APS risk stratification is poorly understood. The manifestation spectrum of APS is wide, ranging from asymptomatic aPLs positivity to life-threatening catastrophic APS, and patients other than confirmed APS also need proper management. Therefore, a risk stratification integrating demographic data, aPL-related manifestations, aPLs profiles, coexisting cardiovascular risk factors and SLE is needed for management guidance and prognosis assessment.

Objectives:

Using cluster analysis, to identify phenotypes among aPL-positive patients and assess the prognosis of each phenotype.

Methods:

This is a single-center, prospective cohort study of aPL-positive patients who presented to Peking Union Medical College Hospital from 2004 to 2020. Demographic characteristics, aPL-related manifestations, cardiovascular risk factors, antibodies profile and follow-up data were recorded. The primary end point was defined as a combination of newly onset arterial thrombosis (AT) or deep venous thrombosis (DVT), major bleeding events, non-criteria manifestations and all-cause death. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of patients and variables separately. Multiple comparison and Kaplan-Meier survival analysis were performed among clusters.

Results:

Four clusters among 383 patients (70.2% female; mean age 37.7 years) were identified (Figure 1A). Cluster 1 (n=138): female patients with SLE, non-criteria manifestations, triple aPLs positivity, high AT rate and moderate DVT rate. Cluster 2 (n=112): male patients with obesity, smoking history, hypertension, hyperhomocysteinemia, triple aPLs positivity and the highest rate of AT and DVT. Cluster 3 (n=83): female patients with the highest pregnancy morbidity rate and the lowest thrombosis rate. Cluster 4 (n=50): 62% male patients with isolated LA positivity, high AT rate and moderate DVT rate. Four clusters of variables were also identified (Figure 1A). From Kaplan-Meier survival analysis, 1-, 5- and 10-year event-free survival rates were 92.6%, 79.8% and 66.8%, respectively. Cluster 3 showed lowest incidence of primary endpoint (Figure 1B), while Cluster 1 and 2 showed higher newly-onset AT risk compared with other clusters (P=0.028 for 2 vs 3 and P=0.049 for 2 vs 4).

Figure 1.

Conclusion:

We identified 4 clinical phenotypes of aPL-positive patients. APS secondary to SLE was always aggregated with non-criteria manifestations. Clinicians should be alert to the possibility of SLE in aPL-positive patients with coexisting non-criteria manifestations, for whom immunosuppressive therapy besides anticoagulation may be necessary. Cluster 4 represented patients with isolated LA positivity and shared similar prognosis with secondary APS and male patients, which confirmed that LA represented a high-risk antibody spectrum. Additionally, cardiovascular risk factors (i.e. male, smoking history and obesity) played an important role in thrombosis events, and led to poor prognosis. Therefore, more attention should be paid to male patients, and the screening and management of cardiovascular risk factors should not be ignored.

References:

[1]Tektonidou MG, Andreoli L, Limper M et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296–304.

[2]Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.

Disclosure of Interests:

None declared.