Simplified integration of optimal self-management behaviors is associated with improved HbA1c in patients with type 1 diabetes

PURPOSE

Living with type 1 diabetes requires burdensome and complex daily diabetes self-management behaviors. This study aimed to determine the association between integrated behavior performance and HbA1c, while identifying the behavior with the most significant impact on HbA1c.

METHODS

A simple and feasible questionnaire was used to collect diabetes self-management behavior in patients with type 1 diabetes (n = 904). We assessed six dimensions of behavior performance: continuous glucose monitor (CGM) usage, frequent glucose testing, insulin pump usage, carbohydrate counting application, adjustment of insulin doses, and usage of apps for diabetes management. We evaluated the association between these behaviors and HbA1c.

RESULTS

In total, 21.3% of patients performed none of the allotted behavior, while 28.5% of patients had a total behavior score of 3 or more. 63.6% of patients with a behavior score ≥ 3 achieved HbA1c goal, contrasting with only 30.4% of patients with a behavior score of 0-1. There was a mean 0.54% ± 0.05% decrease in HbA1c for each 1-unit increase in total behavior score after adjustment for age, family education and diabetes duration. Each behavior was independently correlated with a lower HbA1c level, with CGM having the most significant effect on HbA1c levels.

CONCLUSIONS

Six optimal self-management behaviors, especially CGM usage, were associated with improved glycemic control, emphasizing the feasibility of implementing a simplified version of DSMES in the routine clinical care.

REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT03610984.

Impact of long-term vs. short-term and single day vs. single dose of antibiotic prophylaxis in reducing infection rates after orthognathic surgery: a systematic review and meta-analysis

BACKGROUND

This review was designed to examine the effect of long-term (≥2 days) vs. short-term (1 day) and single-day vs. single preoperative doses of antibiotic prophylaxis on surgical site infection (SSI) rates after orthognathic surgery.

MATERIAL AND METHODS

PubMed, Web of Science, Embase, and Scopus were searched for randomized controlled trials (RCTs) without any date or language restriction till 1st September 2023. SSI rates were pooled to generate risk ratio (RR).

RESULTS

Eight RCTs comparing long-term vs. short-term and three RCTs comparing single day vs. single preoperative dose of antibiotic prophylaxis were included. Meta-analysis showed that the use of long-term antibiotic prophylaxis significantly reduced the risk of SSI after orthognathic surgery as compared to short-term antibiotics [RR:0.42 (95% CI: 0.23, 0.76) I2=0%]. Meta-analysis also noted that patients receiving a single day of antibiotic prophylaxis had significantly reduced risk of SSI as compared to those receiving only a preoperative single dose of antibiotics [RR:0.28 (95%: 0.09, 0.82) I2=0%].

CONCLUSIONS

Evidence from a limited number of RCTs with moderate to high risk of bias shows that two to seven days of long-term antibiotic prophylaxis reduces the risk of SSI as compared to single-day antibiotic therapy. Also, a single day of antibiotics may be more beneficial than a single pre-operative dose of antibiotic.

Deep learning for the early identification of periodontitis: a retrospective, multicentre study

AIM

To develop a deep-learning model to help general dental practitioners diagnose periodontitis accurately and at an early stage.

MATERIALS AND METHODS

First, the panoramic radiographs (PARs) from the Second Affiliated Hospital of Nanchang University were input into the convolutional neural network (CNN) architecture to establish the PAR-CNN model for healthy controls and periodontitis patients. Then, the PARs from the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were included in the second testing set to validate the effectiveness of the model with data from two centres. Heat maps were produced using a gradient-weighted class activation mapping method to visualise the regions of interest of the model. The accuracy and time required to read the PARs were compared between the model, periodontal experts, and general dental practitioners. Areas under the receiver operating characteristic curve (AUCs) were used to evaluate the performance of the model.

RESULTS

The AUC of the PAR-CNN model was 0.843, and the AUC of the second test set was 0.793. The heat map showed that the regions of interest predicted by the model were periodontitis bone lesions. The accuracy of the model, periodontal experts, and general dental practitioners was 0.800, 0.813, and 0.693, respectively. The time required to read each PAR by periodontal experts (6.042 ± 1.148 seconds) and general dental practitioners (13.105 ± 3.153 seconds), which was significantly longer than the time required by the model (0.027 ± 0.002 seconds).

CONCLUSION

The ability of the CNN model to diagnose periodontitis approached the level of periodontal experts. Deep-learning methods can assist general dental practitioners to diagnose periodontitis quickly and accurately.

Toripalimab Plus Chemotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma: The JUPITER-02 Randomized Clinical Trial

Importance

There are currently no therapies approved by the US Food and Drug Administration for nasopharyngeal carcinoma (NPC). Gemcitabine-cisplatin is the current standard of care for the first-line treatment of recurrent or metastatic NPC (RM-NPC).

Objective

To determine whether toripalimab in combination with gemcitabine-cisplatin will significantly improve progression-free survival and overall survival as first-line treatment for RM-NPC, compared with gemcitabine-cisplatin alone.

Design, Setting, and Participants

JUPITER-02 is an international, multicenter, randomized, double-blind phase 3 study conducted in NPC-endemic regions, including mainland China, Taiwan, and Singapore. From November 10, 2018, to October 20, 2019, 289 patients with RM-NPC with no prior systemic chemotherapy in the RM setting were enrolled from 35 participating centers.

Interventions

Patients were randomized (1:1) to receive toripalimab (240 mg [n = 146]) or placebo (n = 143) in combination with gemcitabine-cisplatin for up to 6 cycles, followed by maintenance with toripalimab or placebo until disease progression, intolerable toxicity, or completion of 2 years of treatment.

Main Outcome

Progression-free survival as assessed by a blinded independent central review. Secondary end points included objective response rate, overall survival, progression-free survival assessed by investigator, duration of response, and safety.

Results

Among the 289 patients enrolled (median age, 46 [IQR, 38-53 years; 17% female), at the final progression-free survival analysis, toripalimab treatment had a significantly longer progression-free survival than placebo (median, 21.4 vs 8.2 months; HR, 0.52 [95% CI, 0.37-0.73]). With a median survival follow-up of 36.0 months, a significant improvement in overall survival was identified with toripalimab over placebo (hazard ratio [HR], 0.63 [95% CI, 0.45-0.89]; 2-sided P = .008). The median overall survival was not reached in the toripalimab group, while it was 33.7 months in the placebo group. A consistent effect on overall survival, favoring toripalimab, was found in subgroups with high and low PD-L1 (programmed death-ligand 1) expression. The incidence of all adverse events, grade 3 or greater adverse events, and fatal adverse events were similar between the 2 groups. However, adverse events leading to discontinuation of toripalimab or placebo (11.6% vs 4.9%), immune-related adverse events (54.1% vs 21.7%), and grade 3 or greater immune-related adverse events (9.6% vs 1.4%) were more frequent in the toripalimab group.

Conclusions and Relevance

The addition of toripalimab to chemotherapy as first-line treatment for RM-NPC provided statistically significant and clinically meaningful progression-free survival and overall survival benefits compared with chemotherapy alone, with a manageable safety profile. These findings support the use of toripalimab plus gemcitabine-cisplatin as the new standard of care for this patient population.

Trial Registration

ClinicalTrials.gov Identifier: NCT03581786.

[Feasibility of a three-sided encapsulation procedure based on fascia anatomy in laparoscopic lateral lymph node dissection for middle and low rectal cancer]

Objective: To explore the feasibility and value of performing a three-sided encapsulation procedure based on fascia anatomy in laparoscopic lateral lymph node dissection (LLND) for middle and low rectal cancer. Methods: This was a retrospective review. The study cohort comprised patients who met the diagnostic criteria for rectal cancer according to the Chinese Guidelines for the Diagnosis and Treatment of Colorectal Cancer, had a short lymph node diameter of >5 mm on the lateral side within the 15 days before surgery, were evaluated as feasible candidates for laparoscopic total mesorectal excision+LLND surgery, had been diagnosed with low or intermediate level rectal cancer, and whose tumor was less than 8 cm away from the anal verge according to pathological examination of the operative specimen. Patients with a history of other malignant tumors of the abdomen or with incomplete follow-up data were excluded. Forty-two patients with middle and low rectal cancer who had undergone lateral lymph node dissection in diagnosis and treatment center of Gastrointestinal Cancer of Guangdong Hospital of Chinese Medicine from Jan.2018 to Dec.2022 were enrolled. There were 24 men (57.1%) and 18 women (42.9%) aged 58.4±11.8 years and the median BMI was 22.5 (19.3-24.1) kg/m2. The main point of the three-sided encapsulation procedure is to expand the external side medial to the external iliac artery and vein, narrowing the range of exterior side dissection. The anterior-medial side is designed to expand the vesical fascia to define the range of anterior-medial side extension. The internal side is fully extended to the ureterohypogastric nerve fascia; the distal point of the caudal extension reaches the level of the Alcock canal and the bottom reaches the piriformis, enabling dissection of the obturator nerve and No.283 lymph nodes. No.263D lymph nodes are dissected by exposing the internal iliac artery and its branches, dissecting the group No.263P lymph nodes, and severing the inferior vesical artery. Finally, the lateral lymphatic tissue is completely resected. Relevant variables were recorded, including the number of lateral lymph nodes detected, the rate of lymph node metastasis, operation duration, intraoperative blood loss, postoperative complications, postoperative hospital stay, and 3-year overall survival rate. Results: Laparoscopic surgery was successfully completed in all patients with no conversions to open surgery and no intraoperative complications. Twenty-seven (64.3%) of the study patients underwent left-sided LLND, 10 (23.8%) right-sided LLND, and five (11.9%) bilateral LLND, with lymph nodes cleared on both sides. All patients' lymph nodes were examined pathologically. A median of 17.0 (11.7, 26.0) lymph nodes was detected, the median of lateral lymph nodes being 5.0 (2.0, 10.2). The median operation time was 254.5 (199.0, 325.2) minutes. The median intra-operative blood loss was 50.0 (30.0, 100.0) mL. All patients were diagnosed with adenocarcinoma by pathological examination of the operative specimen. Two patients developed postoperative intestinal obstruction, one lymphatic leakage, and one a perineal incision infection. There were no cases of anastomotic leakage. The median postoperative hospital stay was 6.0 (5.0, 7.0) days and the median follow-up time 23.5 (9.0, 36.7) months. During follow-up, three patients (7.1%) died of tumor recurrence and metastasis. Two (4.8%) experienced mild urinary dysfunction, and one (2.4%) had moderate postoperative erectile dysfunction. One patient (2.4%) was found to have prostate and lung metastases 3 month after surgery. The 3-year overall survival rate was 74.4%. Conclusions: Three sided encapsulation is a safe and feasible procedure for LLND, achieving accurate and complete clearance of lateral lymphatic tissue.

The Role of Radiation Therapy for Metastatic Cervical Cancer

PURPOSE/OBJECTIVE(S)

Survival rates for women with metastatic cervical cancer (CC) are low, with limited management options. Radiation therapy (RT) for metastatic disease has led to prolonged survival in other malignancies, however, the data are scarce in CC. Herein, we evaluated the effect of RT for metastatic CC.

MATERIALS/METHODS

A total of 58 patients with metastatic CC between September 2019 and January 2023 were retrospectively analyzed. All the patients were treated with platinum-based chemotherapy combined with targeted therapy or immunotherapy followed with or without RT (NRT). The recent efficacy, survival status and prognostic factors were analyzed statistically.

RESULTS

Objective response rate (ORR) was 63.6% with one complete and twenty partial responses in RT group (n = 33) and 40.0% with two complete and eight partial responses in NRT group (n = 25), respectively (p = 0.074). Disease control rate (DCR) of the RT and NRT groups were 79.4% vs 80.0%, respectively (p = 0.861). Median follow-up time was 17 months (3-39months). In RT group, 11(33.3%) patients experienced local regional or distant failure and 9 (27.3%) patients were dead. In NRT group, 15(60%) patients had progression and 8 (32%) patients dead. There was no significant difference between the two groups in overall survival (OS); however, RT group displayed superior progression-free survival (PFS) (1-year OS: 72.7% vs. 68.0%, p = 0.460; 1-year PFS: 66.7% vs. 40.0%, p = 0.039). The multivariate analysis showed that RT, immunotherapy, lymph node metastasis only relevant predictor of superior PFS but not OS. In subgroup analysis, patients treated with RT appeared to have a better PFS in some specific cohorts, such as age>45 years (72.0% vs 36.4% P = 0.015), squamous carcinoma histology (71.0% vs 40.9% P = 0.017), metastatic at diagnosis (75.0% vs 47.6% P = 0.012), non-targeted therapy (72.4% vs 43.8% P = 0.040). No significant increase in treatment-related toxicity was observed in the RT group compared with the NRT group.

CONCLUSION

RT provided superior PFS in metastatic CC patients compared to NRT, and well tolerated. Moreover, RT, immunotherapy, lymph node metastasis only were independent significant prognostic factors for PFS. Subgroup analysis showed that combination of RT and chemotherapy obtained favorable PFS in metastatic CC patients with age>45 years, squamous carcinoma histology, metastatic at diagnosis, non-targeted therapy. Studies with a larger sample size and longer follow-up are warranted.

Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial

PURPOSE/OBJECTIVE(S)

CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316.

MATERIALS/METHODS

Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety.

RESULTS

From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%).

CONCLUSION

SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.

Changes and Relationship in Nutrition Impact Symptoms, Malnutrition during Esophageal Cancer Treatment

PURPOSE/OBJECTIVE(S)

The aim of this study was to assess the changes and relationship between nutritional impact symptoms (NIS) and malnutrition incidence during radiotherapy in patients with esophageal cancer.

MATERIALS/METHODS

A prospective observational study recruited hospitalized patients with esophageal cancer who received radiotherapy or did not receive chemotherapy. 283 patients with esophageal carcinoma were followed up before and during the fourth week of radiotherapy. Nutritional parameters were collected during radiotherapy.

RESULTS

According to the patient 's assessment of NIS and subjective global assessment (PG-SGA), at the mid-term of radiotherapy, the proportion of patients with NIS≥3 increased from 20.8% to 61.13%. Inappetence (37.1%) and abdominal distension (28.6%) were the most common nutritional symptoms. Severe malnutrition increased from 39% to 58.1%.NIS (odds ratio (OR) 30.93, 95% CI 15.92, 60.10, p <0.001) and weight loss of ≥5% (odds ratio (OR) 24.1, 95% CI 11.98, 48.47, p <0.001) were independently associated with severe malnutrition during radiotherapy.

CONCLUSION

Strengthen the nutritional support therapy during mid-radiotherapy for esophageal cancer patient, and NIS can directly predict malnutrition.PG-SGA and NIS can be used for nutritional monitoring in esophageal cancer patients.

Outcomes of Consolidative Thoracic Radiation within First-Line Chemoimmunotherapy in Extensive-Stage Small-Cell Lung Cancer: Results from a Single Cancer Center

PURPOSE/OBJECTIVE(S)

Thoracic radiation (TRT) benefits local control undoubtedly and survival with some minor controversy in extensive-stage small-cell lung cancer (ES-SCLC) patients undergoing radiotherapy in the chemoradiotherapy era. However, whether TRT could further enhance the benefit of immune checkpoint inhibitors (ICIs) maintenance on outcomes in the immunotherapy era is still unclear. This study aims to investigate the role of consolidative TRT in ES-SCLC patients receiving first-line chemoimmunotherapy followed by immunotherapy maintenance.

MATERIALS/METHODS

Outcomes of patients who were treated with first-line chemo-immunotherapy followed by ICIs maintenance for ES-SCLC were reviewed. Based on TRT or not, patients were allocated to TRT group or non-TRT group. Progression-free survival (PFS), overall survival (OS) and local-recurrence free survival (LRFS) were calculated by the Kaplan-Meier method and compared by log-rank test.

RESULTS

A total of 100 patients with no progressive disease after 4 cycles of chemotherapy were retrospectively analyzed between January 2020 and December 2021 and were allocated into TRT group (n = 47) and non-TRT group (n = 53). The median follow-up time was 20.3 months. The median PFS and OS in TRT were 9.1 months and 21.8 months, versus 8.8 months (p = 0.93) and 24.3 months (p = 0.63), respectively, in non-TRT. ICIs agents consisted of Durvalumab (59.0%) and Atezolizumab (41.0%). The median dose of TRT is 50 Gy (IQR: 45 - 54), while the median interval time from chemotherapy completion to TRT was 31 days (IQR: 12 - 44.5). Only 10 (21.3%) patients terminated ICIs in the period of TRT. The rate of intrathoracic progression after the first-line therapy in TRT significantly decreased compared to that with non-TRT (20.0% versus 55.9%, p = 0.003). The median LRFS time in TRT was not reached, but significantly longer than 10.8 months in non-TRT (HR = 0.27, p < 0.01). Second-line chemotherapy significantly prolonged survival compared to that with chemo-free patients (mOS: 24.5 vs. 21.4 months, p = 0.026). The subgroup analysis showed a trend of patients with brain metastases benefit from TRT (21.8 versus 13.7 months, HR 0.61, p = 0.38) while liver metastases did not (13.3 versus 15.0 months, HR 1.80, p = 0.21). Of 47 patients with TRT, only 10.6% of patients experienced grade 3 radiation-induced pneumonitis, while no grade 4 or 5 adverse events occurred. None of patients experienced grade ≥ 3 treatment-related cardiac events.

CONCLUSION

Consolidative TRT in the period of immunotherapy maintenance followed first-line chemo-immunotherapy did not prolong OS and PFS but increased LRFS in ES-SCLC.

[Experimental study on the molluscicidal activity of surfactin against Oncomelania hupensis]

OBJECTIVE

To evaluate the molluscicidal activity of surfactin against Oncomelania hupensis, so as to provide the experimental basis for use of Bacillus for killing O. hupensis.

METHODS

O. hupensis snails were collected from schistosomiasisendemic foci of Wuhu City on September 2022, and Schistosoma japonicum-infected snails were removed. Then, 60 snails were immersed in surfactin at concentrations of 2, 1, 0.5, 0.25, 0.125 mg/mL and 0.062 5 mg/mL for 24, 48, 72 hours at 26 °C, while ultrapure water-treated snails served as controls. The median lethal concentration (LC50) of surfactin against O. hupensis snails was estimated. O. hupensis snails were immersed in surfactin at a concentration of 24 h LC50 and ultrapure water, and then stained with propidium iodide (PI). The PI uptake in haemocyte was observed in O. hupensis snails using fluorescence microscopy.

RESULTS

The mortality of O. hupensis was 5.0% following immersion in surfactin at a concentration of 0.062 5 mg/mL for 24 h, and the mortality was 100.0% following immersion in surfactin at a concentration of 2 mg/mL for 72 h, while no snail mortality was observed in the control group. There were significant differences in the mortality of O. hupensis in each surfactin treatment groups at 24 (χ2 = 180.150, P < 0.05), 48 h (χ2 = 176.786, P < 0.05) and 72 h (χ2 = 216.487, P < 0.05), respectively. The average mortality rates of O. hupensis were 38.9% (140/360), 62.2% (224/360) and 83.3% (300/360) 24, 48 h and 72 h post-immersion in surfactin, respectively (χ2 = 150.264, P < 0.05), and the 24, 48 h and 72 h LC50 values of surfactin were 0.591, 0.191 mg/mL and 0.054 mg/mL against O. hupensis snails. Fluorescence microscopy showed more numbers of haemocytes with PI uptake in 0.5 mg/mL surfactintreated O. hupensis snails than in ultrapure water-treated snails for 24 h, and there was a significant difference in the proportion of PI uptake in haemocytes between surfactin-and ultrapure water-treated snails (χ2 = 6.690, P < 0.05).

CONCLUSIONS

Surfactin is active against O. hupensis snails, which may be associated with the alteration in the integrity of haemocyte membrane.

Genomic features of recombinant CHO clones arising from transposon-based and randomized integration

The use of transposase in cell line development (CLD) programs has experienced increased popularity over the past decade. However, few studies have described the mechanism of action and the genomic and phenotypic characteristics of clones derived from transposase. Additionally, how these traits impact long-term bioproduction is unknown. Here, we use chromosome painting, deep sequencing, and ddPCR to characterize the unique fingerprints associated with transposase-derived clones. Transposase reduces the cellular pool of transient vector as early as three days post transfection following transfection and expedites stable pool establishment by up to two weeks. Furthermore, recombinant DNA expression is significantly improved up to ∼3 fold along with a greater balance of antibody heavy and light chain transcripts, resulting in higher titers in transposase generated pools. Transposase derived pools contained an often innumerable number of integration sites, representing a vast increase in integration site diversity over randomly generated pools, which were bottlenecked at 1-3 integration sites per pool. These transposase mediated integrations typically occurred in clean singlets, free of genomic scars such as deletions, inversions, and other modifications associated with legacy transfection methods which exhibited higher copy numbers per integration site. Relative declines in gene expression occur with copy number increase in the randomly generated, but not the transposase derived clones. Furthermore, transposase-derived clones were more likely to exhibit enhanced a long term stability profile, including product quality attributes such as mannose-5. This improved stability may result from circumventing mechanisms associated with the silencing of tandem repeats. Thus, transposase-mediated approaches can provide multifaceted molecular and phenotypic advantages in cell line development when compared to legacy random-integration methods.

[An improved 4-vessel intermittent occlusion method for establishing rat models of global cerebral ischemia-reperfusion injury]

OBJECTIVE

To improve the classical 4-vessel occlusion (4VO) model established by Pulsinelli and Brierley.

METHODS

Thirty-two male SD rats were randomized into sham operation group, I4VO-Con10 group, I4VO-Int10 group and I4VO-Int15 group. The sham surgery group underwent exposure of the bilateral vertebral arteries and carotid arteries without occlusion to block blood flow. The I4VO-Con10 group experienced continuous ischemia by occluding the bilateral vertebral arteries and carotid arteries for 10 minutes followed by reperfusion for 24 hours. The I4VO-Int10 and I4VO-Int15 groups were subjected to intermittent ischemia. The I4VO- Int10 group underwent 5 minutes of ischemia, followed by 5 minutes of reperfusion and another 5 minutes of ischemia, and then reperfusion for 24 hours. The I4VO-Int15 group experienced 5 minutes of ischemia followed by two cycles of 5 minutes of reperfusion and 5 minutes of ischemia, and then reperfusion for 24 hours. The regional cerebral blood flow (rCBF) was monitored with laser Doppler scanning, and survival of the rats was observed. HE staining was used to observe hippocampal pathologies to determine the optimal method for modeling. Another 48 rats were randomized into 6 groups, including a sham operation group and 5 model groups established using the optimal method. The 5 I4VO model groups were further divided based on the reperfusion time points (1, 3, 7, 14, and 28 days) into I4VO-D1, I4VO-D3, I4VO-D7, I4VO- D14, and I4VO- D28 groups. Body weight changes and survival of the rats were recorded. HE staining was used to observe morphological changes in the hippocampal, retinal and optic tract tissues. The Y-maze test and light/dark box test were used to evaluate cognitive and visual functions of the rats in I4VO-D28 group.

RESULTS

Occlusion for 5 min for 3 times at the interval of 5 min was the optimal method for 4VO modeling. In the latter 48 rats, the body weight was significantly lower than that of the sham-operated rats at 1, 3, 7, 14 and 28 days after modeling without significant difference in survival rate among the groups. The rats with intermittent vessel occlusion exhibited progressive deterioration of hippocampal neuronal injury and neuronal loss. Cognitive impairment was observed in the rats in I4VO-D28 group, but no obvious ischemic injury of the retina or the optic tract was detected.

CONCLUSION

The improved 4VO model can successfully mimic the main pathological processes of global cerebral ischemia-reperfusion injury without causing visual impairment in rats.

Influence of 12 weeks of basketball training on college students' heart function

OBJECTIVE

This study aims to investigate the influence of 12 weeks of basketball training on college students' heart function.

SUBJECTS AND METHODS

The subjects were 30 college male basketball players. Carry out 8-week interval training, monitor the training load and interval time of athletes, and strictly control the heart rate during the interval. Before and after training, we used safe and effective experimental instruments - without any damage to the athletes - to detect the relevant indicators of the athletes' physiological functions; hence we compared and analyzed the various indicators before and after training.

RESULTS

The time domain indexes Root Mean Square of Successive Differences (RMSSD), Statistically Determined Spatial Drift (SDSD), percentage of NN50 in the total number of NN intervals (PNN50), and Standard Deviation of all NN intervals for all 5-min segment (SDNN) after training were significantly higher than those before training, and the differences were statistically significant (p<0.05). Average (Avag) and Statistically Determined Allocation Weights (SDAW) after training were significantly higher than those before training, the difference was statistically significant (p<0.05); Asymmetry (Asym) and Tension index (TI) were significantly lower than those before training, the difference was statistically significant (p<0.05), Application Information Index (ApInf) had no significant difference (p>0.05). There was no significant difference in shooting hit rate (p>0.05). The speed of the 8-character dribble in the whole field after training was significantly lower than that before training, and the differences were statistically significant (p<0.05). There was no significant difference in average jump height, maximum jump height, average time in the air, and best jump time in the air after training (p>0.05). For the test of athletes' explosive power, five vertical jumps in situ were selected for testing, and the jump height and time in the air of each vertical jump were counted to calculate the maximum and average values of five vertical jumps. The results showed that there was no significant change in the explosive force of the athletes' lower limbs after training. The reason may be that strength training needs to follow the principles of heavy load, specialization, exercise sequence and reasonable interval. The intermittent training method used during training is not specialized in strength training, and the reasonable interval of strength training was not considered in the training process.

CONCLUSIONS

Intermittent training can increase the tension of the cardiac vagus nerve of college basketball players, increase the cardiac reserve function and the load that the heart can bear, so that the cardiac function can be improved well. It can improve the cardiopulmonary function and aerobic work ability of college basketball players. It can improve the adjustment ability of the heart, lungs, liver, and other organs of college basketball players. It also can increase the load intensity that the central nerve can bear and improve the function of the central nerve and autonomic nerve. The anti-fatigue ability of athletes can be improved. It can improve the speed quality of college basketball players.

[Genotype-environment interaction on arterial stiffness: A pedigree-based study]

OBJECTIVE

To utilized the baseline data of the Beijing Fangshan Family Cohort Study, and to estimate whether the association between a healthy lifestyle and arterial stiffness might be modified by genetic effects.

METHODS

Probands and their relatives from 9 rural areas in Fangshan district, Beijing were included in this study. We developed a healthy lifestyle score based on five lifestyle behaviors: smoking, alcohol consumption, body mass index (BMI), dietary pattern, and physical activity. The measurements of arterial stiffness were brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). A variance component model was used to determine the heritability of arterial stiffness. Genotype-environment interaction effects were performed by the maximum likelihood methods. Subsequently, 45 candidate single nucleotide polymorphisms (SNPs) located in the glycolipid metabolism pathway were selected, and generalized estimated equations were used to assess the gene-environment interaction effects between particular genetic loci and healthy lifestyles.

RESULTS

A total of 6 302 study subjects across 3 225 pedigrees were enrolled in this study, with a mean age of 56.9 years and 45.1% male. Heritability of baPWV and ABI was 0.360 (95%CI: 0.302-0.418) and 0.243 (95%CI: 0.175-0.311), respectively. Significant genotype-healthy diet interaction on baPWV and genotype-BMI interaction on ABI were observed. Following the findings of genotype-environment interaction analysis, we further identified two SNPs located in ADAMTS9-AS2 and CDH13 might modify the association between healthy dietary pattern and arterial stiffness, indicating that adherence to a healthy dietary pattern might attenuate the genetic risk on arterial stiffness. Three SNPs in CDKAL1, ATP8B2 and SLC30A8 were shown to interact with BMI, implying that maintaining BMI within a healthy range might decrease the genetic risk of arterial stiffness.

CONCLUSION

The current study discovered that genotype-healthy dietary pattern and genotype-BMI interactions might affect the risk of arterial stiffness. Furthermore, we identified five genetic loci that might modify the relationship between healthy dietary pattern and BMI with arterial stiffness. Our findings suggested that a healthy lifestyle may reduce the genetic risk of arterial stiffness. This study has laid the groundwork for future research exploring mechanisms of arterial stiffness.

[Comparison of aspirin treatment strategies for primary prevention of cardiovascular diseases: A decision-analytic Markov modelling study]

OBJECTIVE

To compare the expected population impact of benefit and risk of aspirin treatment strategies for the primary prevention of cardiovascular diseases recommended by different guidelines in the Chinese Electronic Health Records Research in Yinzhou (CHERRY) study.

METHODS

A decision-analytic Markov model was used to simulate and compare different strategies of aspirin treatment, including: Strategy ①: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk, recommended by the 2020 Chinese Guideline on the Primary Prevention of Cardiovascular Diseases; Strategy ②: Aspirin treatment for Chinese adults aged 40-59 years with a high 10-year cardiovascular risk, recommended by the 2022 United States Preventive Services Task Force Recommendation Statement on Aspirin Use to Prevent Cardiovascular Disease; Strategy ③: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk and blood pressure well-controlled (< 150/90 mmHg), recommended by the 2019 Guideline on the Assessment and Management of Cardio-vascular Risk in China. The high 10-year cardiovascular risk was defined as the 10-year predicted risk over 10% based on the 2019 World Health Organization non-laboratory model. The Markov model simulated different strategies for ten years (cycles) with parameters mainly from the CHERRY study or published literature. Quality-adjusted life year (QALY) and the number needed to treat (NNT) for each ischemic event (including myocardial infarction and ischemic stroke) were calculated to assess the effectiveness of the different strategies. The number needed to harm (NNH) for each bleeding event (including hemorrhagic stroke and gastrointestinal bleeding) was calculated to assess the safety. The NNT for each net benefit (i.e., the difference of the number of ischemic events could be prevented and the number of bleeding events would be added) was also calculated. One-way sensitivity analysis on the uncertainty of the incidence rate of cardiovascular diseases and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.

RESULTS

A total of 212 153 Chinese adults, were included in this study. The number of people who were recommended for aspirin treatment Strategies ①-③ was 34 235, 2 813, and 25 111, respectively. The Strategy ③ could gain the most QALY of 403 [95% uncertainty interval (UI): 222-511] years. Compared with Strategy ①, Strategy ③ had similar efficiency but better safety, with the extra NNT of 4 (95%UI: 3-4) and NNH of 39 (95%UI: 19-132). The NNT per net benefit was 131 (95%UI: 102-239) for Strategy ①, 256 (95%UI: 181-737) for Strategy ②, and 132 (95%UI: 104-232) for Strategy ③, making Strategy ③ the most favorable option with a better QALY and safety, along with similar efficiency in terms of net benefit. The results were consistent in the sensitivity analyses.

CONCLUSION

The aspirin treatment strategies recommended by the updated guidelines on the primary prevention of cardiovascular diseases showed a net benefit for high-risk Chinese adults from developed areas. However, to balance effectiveness and safety, aspirin is suggested to be used for primary prevention of cardiovascular diseases with consideration for blood pressure control, resulting in better intervention efficiency.

[Application of veno-arterio-venous extracorporeal membrane oxygenation in patients with critical respiratory failure combined with refractory shock]

Objective: To preliminarily analyze the application experience of veno-arterio-venous extracorporeal membrane oxygenation (VAV-ECMO).The VAV-ECMO is a rescue strategy for patients with extremely critical respiratory failure combined with refractory shock. Methods: From February 2016 to February 2022, the characteristics and outcomes of patients who were started on either veno-venous or veno-arterial ECMO due to respiratory or hemodynamic failure, and then converted to VAV-ECMO in respiratory intensive care unit (ICU) of Beijing Chaoyang Hospital were analyzed. Results: A total of 15 patients underwent VAV-ECMO, aged 53 (40, 65) years, and 11 of whom were male. Within the group, VV-ECMO was initially used in 12 patients due to respiratory failure, but then VAV-ECMO was used due to cardiogenic shock (7/12) and septic shock (4/12), while VAV-ECMO was established in two patients due to lung transplantation. One patient was diagnosed with pneumonia complicated by septic shock, which was initially determined to be VA-ECMO, but then switched to VAV-ECMO because it was difficult to maintain oxygenation. The time from the establishment of VV or VA-ECMO to the switch to VAV-ECMO was 3 (1, 5) days and the VAV-ECMO support time was 5 (2, 8) days. ECMO-related complications were bleeding, mostly in the digestive tract (n=4) and airway hemorrhage (n=4), without intracranial hemorrhage, and poor arterial perfusion of the lower limbs (n=2). Among these 15 patients, the overall ICU mortality was 53.3%. The mortality of patients who received VAV-ECMO due to septic shock and cardiogenic shock was 100% (4/4) and 42.8% (3/7), respectively. Two patients who received VAV-ECMO due to lung transplantation all survived. Conclusion: VAV-ECMO may be a safe and effective treatment for carefully selected patients with critical respiratory failure associated with cardiogenic shock or end-stage lung disease lung transplantation transition, however, patients with septic shock may benefit the least.

[Application of discrete event simulation model in analysis on cost-effectiveness of epidemiology screening]

Discrete event simulation (DES) model is based on individual data, by which discrete events over time are simulated to reflect disease progression. The effects of individual characteristics on disease progression could be considered in the DES model. Moreover, unlike state-transition models, DES model without setting of fixed cycle can contribute to more accurate estimation of event time, especially in the evaluation of the long-term effectiveness of screening strategies for complex diseases in which time dimension needs to be considered. This article introduces the general principles, construction steps, analytic methods and other relevant issues of the DES model. Based on a research case of estimating the cost-effectiveness of screening for abdominal aortic aneurysms in women aged 65 years and above in the United Kingdom, key points in applications of the DES model in analysis on effectiveness of complex disease screening are discussed in detail, including model construction and analysis and interpretation of the results. DES model can predict occurring time of discrete events accurately by establishing the distribution function of their occurring time and is increasingly used to evaluate the screening strategies for complex diseases in which time dimension needs to be considered. In the construction of DES model, it is necessary to pay close attention to the clear presentation of model structure and simulation process and follow the relevant reporting specification to conduct cost-effectiveness analysis to ensure the transparency and repeatability of the research.

Activation cross sections for reactions induced by 14 MeV neutrons on natural titanium

Cross sections for the neutrons around 14 MeV interaction with natural titanium were precisely measured by neutron activation and off-line measurement technique. The fast neutrons were produced by ³H(d,n)⁴He reaction and the neutron energy was obtained by using the cross section ratio method of ⁹⁰Zr(n,2n)⁸⁹Zr to ⁹³Nb(n,2n)^92mNb reactions. Experimental cross sections have been acquired for ^natTi(n,x)⁴⁶Sc, ^natTi(n,x)⁴⁷Sc, ⁵⁰Ti(n,x)⁴⁷Ca and ⁴⁸Ti(n,x)⁴⁸Sc reactions. The measured cross section data are compared with the experimental data available in the previous literature and evaluated nuclear data from the ENDF/B-VIII.0, JEFF-3.3, JENDL-5, BROND-3.1, CENDL-3.2 and FENDL-3.2b libraries. Furthermore, excitation functions for these reactions were calculated by using the theoretical model based on Talys-1.96 code with default and adjusted parameters. Within experimental error, evaluated nuclear data are mostly consistent with experimental data. The excitation function with adjusted parameters can roughly reproduce the experimental data.

Toripalimab Plus Chemotherapy for Patients With Treatment-Naive Advanced Non-Small-Cell Lung Cancer: A Multicenter Randomized Phase III Trial (CHOICE-01)

PURPOSE

The CHOICE-01 study investigated the efficacy and safety of toripalimab in combination with chemotherapy as a first-line treatment for advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients (N = 465) with treatment-naive, advanced NSCLC without EGFR/ALK mutations were randomly assigned 2:1 to receive toripalimab 240 mg (n = 309) or placebo (n = 156) once every 3 weeks in combination with chemotherapy for 4-6 cycles, followed by the maintenance of toripalimab or placebo once every 3 weeks plus standard care. Stratification factors included programmed death ligand-1 expression status, histology, and smoking status. The primary end point was progression-free survival (PFS) by investigator per RECIST v1.1. Secondary end points included overall survival and safety.

RESULTS

At the final PFS analysis, PFS was significantly longer in the toripalimab arm than in the placebo arm (median PFS, 8.4 v 5.6 months, hazard ratio = 0.49; 95% CI, 0.39 to 0.61; two-sided P < .0001). At the interim OS analysis, the toripalimab arm had a significantly longer OS than the placebo arm (median OS not reached v 17.1 months, hazard ratio = 0.69; 95% CI, 0.53 to 0.92; two-sided P = .0099). The incidence of grade ≥ 3 adverse events was similar between the two arms. Treatment effects were similar regardless of programmed death ligand-1 status. Genomic analysis using whole-exome sequencing from 394 available tumor samples revealed that patients with high tumor mutational burden were associated with significantly better PFS in the toripalimab arm (median PFS 13.1 v 5.5 months, interaction P = .026). Notably, patients with mutations in the focal adhesion-PI3K-Akt signaling pathway achieved significantly better PFS and OS in the toripalimab arm (interaction P values ≤ .001).

CONCLUSION

Toripalimab plus chemotherapy significantly improves PFS and OS in patients with treatment-naive advanced NSCLC while having a manageable safety profile. Subgroup analysis showed the OS benefit was mainly driven by the nonsquamous subpopulation.

Nomogram Based on Clinical and Radiomics Data for Predicting Radiation-induced Temporal Lobe Injury in Patients with Non-metastatic Stage T4 Nasopharyngeal Carcinoma

AIMS

To use pre-treatment magnetic resonance imaging-based radiomics data with clinical data to predict radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients with stage T4/N0-3/M0 within 5 years after radiotherapy.

MATERIALS AND METHODS

This study retrospectively examined 98 patients (198 temporal lobes) with stage T4/N0-3/M0 NPC. Participants were enrolled into a training cohort or a validation cohort in a ratio of 7:3. Radiomics features were extracted from pre-treatment magnetic resonance imaging that were T1-and T2-weighted. Spearman rank correlation, the t-test and the least absolute shrinkage and selection operator (LASSO) algorithm were used to select significant radiomics features; machine-learning models were used to generate radiomics signatures (Rad-Scores). Rad-Scores and clinical factors were integrated into a nomogram for prediction of RTLI. Nomogram discrimination was evaluated using receiver operating characteristic analysis and clinical benefits were evaluated using decision curve analysis.

RESULTS

Participants were enrolled into a training cohort (n = 139) or a validation cohort (n = 59). In total, 3568 radiomics features were initially extracted from T1-and T2-weighted images. Age, D_max, D_1cc and 16 stable radiomics features (six from T1-weighted and 10 from T2-weighted images) were identified as independent predictive factors. A greater Rad-Score was associated with a greater risk of RTLI. The nomogram showed good discrimination, with a C-index of 0.85 (95% confidence interval 0.79-0.92) in the training cohort and 0.82 (95% confidence interval 0.71-0.92) in the validation cohort.

CONCLUSION

We developed models for the prediction of RTLI in patients with stage T4/N0-3/M0 NPC using pre-treatment radiomics data and clinical data. Nomograms from these pre-treatment data improved the prediction of RTLI. These results may allow the selection of patients for earlier clinical interventions.

PD-L1 Expression in Cytological and Histological Lung Cancer Specimens

Introduction/Objective

Several studies have explored the feasibility of measuring PD-L1 in cell block cytology and indicated cytological materials could be a reliable source for PD-L1 evaluation in non-small cell lung carcinoma patients. A few studies have investigated the compatibility and performance of PD-L1 clone SP263 testing between cytology and histology specimens. The study was pursued to evaluate PD-L1 expression in cell blocks from EBUS- TBNA compared to that in biopsied tissues from patients with lung carcinoma in our institution to evaluate a feasibility of PD-L1 clone SP263 in cell blocks and histology samples.

Methods/Case Report

A total of 57 specimens cytologically diagnosed lung carcinoma using endobronchial ultrasound guided transbronchial needle aspiraton (EBUS-TBNA) from Jan 1st, 2020, to Dec 31st, 2021 were screened for enrollment. Among them, 24 patients diagnosed with lung carcinoma using EBUS-TBNA and matched transbronchial biopsy (TBB) specimens were reviewed for study. After careful selection, 13 paired formalin-fixed tissues from lung carcinoma patients, including cell blocks and matched histology samples, were included. PD-L1 expression was assessed using the SP263 assay, and the tumor proportion score (TPS) was evaluated. PD-L1 expression was finally divided into three categories according to the TPS: &lt; 1% (negative), 1–49% (low expression) and ≥ 50% (high expression).

Results (if a Case Study enter NA)

Of the 13 matched pairs, 12 (92.3%) showed concordant PD-L1 expression. On cytology, 3 cases were positive (2 high expressors and 1 low- expressors) of which 2 were concordant and 1 discordant with matched histology specimens. Ten cytology samples were negative for PD-L1 expression, and they were concordant to histology samples. The correlation coefficient for TPS was 0.75 considered as having good value. Conclusion: With an overall concordance rate of 92.3% between cytology and histology specimen, this study demonstrates the feasibility of PD-L1 IHC with SP263 clone on limited quality and quantity of cytology samples from lung carcinoma in our institute. It is required for further evaluation with additional specimens to conclude that the usefulness of cytology cell blocks for PD-L1 expression analysis.

[Safety and efficacy of a new domestic distal perforated stent graft in the treatment of Stanford type B aortic dissection]

Objective: To evaluate the safety and efficacy of a new domestic distal perforated stent graft (Talos stent) in the treatment of Stanford type B aortic dissection (TBAD). Methods: Twenty-five patients with TBAD treated with Talos stent in Yan'an Hospital Affiliated to Kunming Medical University from February 2018 to December 2019 were selected as the research subjects. Intraoperative angiography was performed to determine the number of branch arteries that remained after stent release. On postoperative day 5 (POD5), the pain intensity of the patients was evaluated by visual analog scale (VAS). The computed tomography angiography (CTA) of the patients before operation, 6 months and 12 months after operation were compared including aortic diameter, true lumen diameter, and false lumen diameter at the level of tracheal bifurcation. Follow-up was performed 1 month, 6 months, 12 months, and 24 months after surgery, and the occurrence of stent-related adverse events, reoperation and survival rate were recorded. Results: The enrolled patients included 19 males and 6 females, aged (52.6±11.1) years. Intraoperative angiography showed that 4 (1, 7) branch arteries were preserved, and the VAS score was 1 (0, 1) on POD5. The aortic diameters at the level of the tracheal bifurcation were (34.9±1.1) mm, (34.6±0.9) mm and (34.8±1.0) mm before surgery, 6 months and 12 months after surgery, and there was no significant difference (P=0.926); the diameters of the main true lumen at the level of the tracheal bifurcation were (13.3±1.6) mm, (21.8±1.0) mm and (22.3±1.1) mm before surgery, 6 months and 12 months postoperatively, while the diameters of the main false lumen at the level of the tracheal bifurcation were (20.8±2.2) mm, (4.5±1.5) mm, and (4.6±1.7) mm, respectively. Compared with before surgery, the diameter of true lumen increased significantly 6 months and 12 months after surgery (both P<0.001), while the diameter of false lumen decreased (both P<0.001). No stent-related adverse events occurred within 30 days after surgery, no secondary operations occurred within 12 months after surgery, no type Ⅰ and type Ⅲ endoleaks, no deaths or cases of paraplegia were reported, and the stent structure and position remained good. There were no deaths or paraplegia cases 24 months postoperatively, and no stent-related adverse events occurred. Conclusion: Using Talos stent in the treatment of TBAD can effectively help remodel the aorta, while preserve the intercostal artery and spinal artery, with good clinical effect and safety.

[Clinical characteristics and outcomes of acute respiratory distress syndrome caused by severe Chlamydia psittaci pneumonia]

Objective: To investigate the clinical characteristics and outcomes of acute respiratory distress syndrome (ARDS) caused by Chlamydia psittaci pneumonia. Methods: From June 2016 to January 2021, 10 cases were diagnosed as severe Chlamydia psittaci pneumonia induced ARDS in Intensive Care Unit of Respiratory and Critical Care Medicine Department (RICU) of Beijing Chao-Yang Hospital Affiliated to Capital Medical University. We collected the clinical data including clinical features, laboratory tests, imaging and outcomes of the patients. Results: The pathogenic diagnosis was confirmed by metagenomic Next-generation Sequencing (mNGS) in these 10 patients, with a median age of 59 (46, 67) years. In addition to high fever, cough and dyspnea, the patients also had multiple organ involvement. Six patients had elevated peripheral leukocyte count, 10 cases had increased type B natriuretic peptide, 7 cases had increased aspartate aminotransferase/alanine aminotransferase, 9 cases had hyponatremia and 3 cases had elevated creatinine. The imaging findings were bilateral consolidation with air bronchogram and infiltrates, and pleural effusion were found in 5 cases. All cases were combined with respiratory failure. Six patients received invasive mechanical ventilation. Nine patients received moxifloxacin and one patient was administrated with Azithromycin. All the patients were improved and discharged after the treatment, and the mean duration of RICU stay was 13.5 (11, 16.7) days. One month follow-up of nine patients showed significant improvement in lung lesions. Conclusions: Severe Chlamydia psittiaci pneumonia may be complicated with respiratory failure and/or multiple organ involvement. For severe pneumonia with an exposure history of sick birds, the possibility of Chlamydia psittaci infection should be considered. mNGS may help etiological diagnosis. All patients in this study had a good prognosis after targeted treatment.

[Exosomal FZD10 derived from non-small cell lung cancer cells promotes angiogenesis of human umbilical venous endothelial cells in vitro]

OBJECTIVE

To investigate the effect of exosomal FZD10 derived from non-small cell lung cancer (NSCLC) cells on angiogenesis of human umbilical venous endothelial cells (HUVECs) and explore the possible mechanism.

METHODS

We analyzed the expression of FZD10 in two NSCLC cell lines (95D and H1299 cells), normal human bronchial epithelial cells (BEAS-2B cells) and their exosomes isolated by ultracentrifugation. Cultured HUVECs were treated with the exosomes derived from NSCLC cells or NSCLC cells transfected with FZD10-siRNA, and the changes in tube formation ability of the cells were analyzed using an in vitro angiogenesis assay. ELISA was performed to determine the concentration of VEGFA and Ang-1 in the conditioned media of HUVECs, and RT-qPCR was used to analyze the mRNA levels of VEGFA and Ang-1 in the HUVECs. The effects of exosomal FZD10 on the activation of PI3K, Erk1/2 and YAP/TAZ signaling pathways were evaluated using Western blotting.

RESULTS

Compared with BEAS-2B cells and their exosomes, 95D and H1299 cells and their exosomes all expressed high levels of FZD10 (P < 0.01). The exosomes derived from 95D and H1299 cells significantly enhanced tube formation ability and increased the expressions of VEGFA and Ang-1 protein and mRNA in HUVECs (P < 0.01), but FZD10 knockdown in 95D and H1299 cells obviously inhibited these effects of the exosomes. Exosomal FZD10 knockdown suppressed the activation of PI3K and Erk1/2 signaling pathways, but had no obvious effect on the activation of YAP/TAZ signaling pathway.

CONCLUSION

Exosomal FZD10 derived from NSCLC cells promotes HUVEC angiogenesis in vitro, the mechanism of which may involve the activation of PI3K and Erk1/2 signaling pathways.

[Predictive value of serum HBV RNA for therapeutic effect of entecavir in patients with chronic hepatitis B]

OBJECTIVE

To investigate the value of HBV RNA for predicting the therapeutic effect of long-term entecavir (ETV) antiviral therapy in patients with chronic hepatitis B (CHB).

METHODS

Serum samples were collected from 59 CHB patients treated with ETV for 96 or 108 months. HBV RNA levels, HBV DNA levels, and serological marker (HBeAg) levels were measured at baseline and 3, 6, 9, 12, 36, 72, and 96 (or 108) months during the therapy.

RESULTS

Although HBV RNA level decreased after 12 and 36 months of ETV antiviral therapy, no significance changes occurred in HBV RNA negative conversion rate (P>0.05). After 72 months of treatment or longer, 33 patients had HBV RNA levels lower than 100 copies/mL, and among them 29 patients had HBV RNA levels lower than the detection limit, and HBV RNA negative conversion rate was statistically significant (P < 0.05). A lower HBV RNA level was associated with a higher HBeAg negative conversion rate (P < 0.05). Age and HBV RNA level were positively correlated with HBeAg negative conversion rate (P < 0.05).

CONCLUSION

Prolonged ETV antiviral therapy results in better clearance of HBV RNA and a higher negative conversion rate in CHB patients. The length of antiviral therapy and age are positively correlated with the negative conversion rate of HBV RNA, and earlier administration of the antiviral treatment achieves better therapeutic effect. Serum HBV RNA level can be used as an indicator for predicting conversion to negative HBeAg in CHB patients receiving ETV therapy.

[Accuracy of the China-PAR and WHO risk models in predicting the ten-year risks of cardiovascular disease in the Chinese population]

Objective: To externally validate and compare the accuracy of the China-PAR (Prediction for ASCVD Risk in China) model and the 2019 World Health Organization (WHO) cardiovascular disease risk charts for East Asian in predicting a 10-year cardiovascular disease in a general Chinese population. Methods: Participants aged 40-79 years without prior cardiovascular disease at baseline in the CHinese Electronic health Records Research in Yinzhou (CHERRY) were analyzed. The Kaplan-Meier analysis estimated the observed cardiovascular events (including non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) rate within ten years. The expected risks were calculated using the WHO risk charts for East Asia (including the laboratory-based and non-laboratory-based models) and the China-PAR model. The expected-observed ratios were calculated to evaluate the overestimation or underestimation of the models in the cohort. Model accuracy was assessed by discrimination C-index, calibration χ² value, and calibration plots. Results: During a median of 7.26 years of follow-up, 13 301 cardiovascular events were identified among 225 811 participants. The C-index for the China-PAR model, WHO laboratory-based model and WHO non-laboratory-based model were 0.741 (0.735-0.747), 0.747 (0.740-0.753), and 0.739 (0.733-0.746) for men, and 0.782 (0.776-0.788), 0.789 (0.783-0.795), and 0.782 (0.776-0.787) for women, respectively. The WHO laboratory-based model and non-laboratory-based model underestimated the 10-year ASCVD risk by around 15% in women and underestimated by 0.8% and 4.4% in men, respectively. The China-PAR model underestimated the risks by 19.5% and 42.3% for men and women. Conclusions: The China-PAR and WHO models all have pretty good discriminations for 10-year cardiovascular risk assessment in this general Chinese population. However, the accuracy should be improved in the highest-risk groups, suggesting further specific models are still needed for those with the highest risk, such as patients with diabetes or older persons.

[Effectiveness of statin treatment strategies for primary prevention of cardiovascular diseases in a community-based Chinese population: A decision-analytic Markov model]

OBJECTIVE

To evaluate the effectiveness of statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases by the Western guidelines in a community-based Chinese population from economically developed areas using data from the Chinese electronic health records research in Yinzhou (CHERRY) study.

METHODS

A Markov model was used to evaluate the effectiveness of the following statin treatment strategies, including: (1) usual care without cardiovascular risk assessment(Strategy 0); (2) using the World Health Organization (WHO) non-laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 1); (3) using the WHO laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 2); and (4) using the Prediction for Atherosclerotic cardiovascular disease Risk in China (China-PAR) model with statin treatment for high-risk group (risk ≥ 10%, Strategy 3). According to the guidelines, adults in the medium-risk group received lifestyle intervention, and adults in the high-risk group received life-style intervention and statin treatment under these strategies. The Markov model simulated different strategies for ten years (cycles) using parameters from the CHERRY study, published data, meta-analyses and systematic reviews for Chinese. The number of cardiovascular events or deaths, as well as the number need to treat (NNT) with statin per cardiovascular event or death prevented, were calculated to compare the effectiveness of different strategies. One-way sensitivity analysis on the uncertainty of incidence rate of cardiovascular diseases, and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.

RESULTS

Totally 225 811 Chinese adults aged 40-79 years without cardiovascular diseases at baseline were enrolled. In contrast to the usual care without risk assessment-based statin treatment strategy, Strategy 1 using the WHO non-laboratory-based risk charts could prevent 3 482 [95% uncertainty interval (UI): 2 110-4 661] cardiovascular events, Strategy 2 using the WHO laboratory-based risk charts could prevent 3 685 (95%UI: 2 255-4 912) events, and Strategy 3 using the China-PAR model could prevent 3 895 (95%UI: 2 396-5 181) events. NNTs with statin per cardiovascular event prevented were 22 (95%UI: 14-54), 21 (95%UI: 14-52), and 27 (95%UI: 17-67), respectively. Strategy 3 could prevent more cardiovascular events, while Strategies 1 and 2 required fewer numbers need to treat with statin per cardiovascular event prevented. The results were consistent in the sensitivity analyses.

CONCLUSION

The statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases recommended by the Western guidelines could achieve substantive health benefits in adults from developed areas of China. Using the China-PAR model for cardiovascular risk assessment could prevent more cardiovascular diseases while using the WHO risk charts seems more efficient.

[Applications of the NDR and DIAL models for risk prediction on cardiovascular disease in patients with type 2 diabetes in Ningbo]

Objective: To validate the performance of cardiovascular risk prediction models based on the Sweden National Diabetes Register (NDR) and Diabetes Lifetime-perspective prediction (DIAL) model for assessing risks of 5-year and 10-year cardiovascular disease (CVD) among Chinese patients with type 2 diabetes. Methods: Based on the Chinese Electronic Health Records Research in Yinzhou study, 83 503 patients with type 2 diabetes aged 30-75 years without a history of CVD at baseline were included from January 1, 2010 to December 31, 2020. Recalibrated NDR model was used to estimate 5-year risk, while the recalibrated DIAL model was used to predict 5-year and 10-year risks. The competing events adjusted Kaplan-Meier analysis was used to obtain the observed cardiovascular events. Discrimination C statistics evaluated model accuracy, calibration χ² value, and calibration plots. Results: Through a median follow-up of 7.0 years, 7 326 cardiovascular events, and 2 937 non-vascular deaths were identified among a total of 83 503 subjects. The recalibrated NDR model overestimated 5-year risk by 39.4% in men and 8.6% in women, whereas the overestimation for the recalibrated DIAL model was 14.6% in men and 50.1% in women. The DIAL model had a better discriminative ability (C-statistic=0.681, 95%CI: 0.672-0.690) than NDR model (C-statistic=0.667, 95%CI: 0.657-0.677) in 5-year risk prediction for men, and the models had a similar ability for women (C-statistic=0.699, 95%CI: 0.690-0.708 for NDR and C-statistic=0.698, 95%CI: 0.689-0.706 for DIAL). The prediction accuracy of the DIAL model was improved in the 10-year risk, with the underestimation being 1.6% for men and the overestimation being 12.8% for women. Conclusions: Both recalibrated NDR and DIAL models overestimated 5-year cardiovascular risk in Chinese patients with type 2 diabetes, while the higher overestimation was shown using the DIAL model. However, the improvement was found in predicting 10-year CVD risk using the DIAL model, which suggested the value of lifetime risk prediction and indicated the need for research on the lifetime risk prediction model for cardiovascular risk assessment in Chinese patients with type 2 diabetes.

[Applications of microsimulation model for cost-effectiveness analysis on screening in epidemiology]

Microsimulation model simulates individuals and estimates transition probabilities within the population using individual participant data. This approach could deal with the heterogeneous characteristics among the people or personal history of diseases and may be relevant in addressing cost-effectiveness problems of screening for complex conditions in epidemiology. This paper introduces the general principles, basic steps involved in implementation, analytic methods, and other related issues of the microsimulation model. Based on a practical research case of estimating the cost-effectiveness of microalbuminuria screening for chronic kidney disease in the United States, critical points in applications of the microsimulation model for cost-effectiveness analysis of screening were discussed in detail, including model development, model analysis, and the interpretation of the results. The microsimulation model considers the dynamic nature of complex diseases by estimating a broad range of individual characteristics and increasingly used to provide insights into complex problems that the Markov model does not efficiently address. For better supporting evidence-informed decision-making in public health, future studies should be aware of the accuracy of parameters in the decision-analytic model and the transparency of the models and results, as well as complying with the relevant reporting standards.

OP0081 IL-13 REDUCES BONE EROSION IN RHEUMATOID ARTHRITIS BY UP-REGULATING OPG IN SYNOVIAL FIBROBLASTS

Background

Bone erosion in rheumatoid arthritis (RA) is partly caused by excessive activation of osteoclasts[1]. Osteoclasts can be derived from RA synovium and their differentiation can be inhibited by OPG, a decoy receptor of the osteoclastogenesis promoting cytokine RANKL[2,3]. Fibroblast-like synoviocytes (FLSs) are a main type of stromal cells in the synovium that can secret OPG[4]. The OPG secretion by FLSs can be modulated by various cytokines[5]. Interleukin (IL)-13 is a cytokine rich in early RA synovial fluid and it decreases as RA progresses[6]. IL-13 was reported to alleviate bone erosion in RA mouse models[7]. However, how IL-13 reduces bone destruction remains unclear.

Objectives

To investigate if IL-13 can inhibit osteoclast differentiation by up-regulating OPG in FLSs of RA patients (RA-FLSs), thus reduces bone erosion in RA.

Methods

FLSs were isolated from the synovium tissue of RA patients with informed consent who underwent joint replacement surgery (Ethics No. 2021-544-01). OPG and RANKL expression by RA-FLSs were evaluated by qRT-PCR. OPG secretion was determined by ELISA. Western blot was performed to analyze OPG expression and the activation of STAT6 pathway. IL-13 and OPG siRNA pre-treated RA-FLSs conditioned medium were used in osteoclast induction to test if IL-13 can inhibit osteoclastogenesis by up-regulating OPG in RA-FLSs. Micro-CT scanning and immunofluorescence were done to determine if IL-13 can induce OPG expression and alleviate bone erosion in vivo.

Results

IL-13 can significantly upregulate OPG expression and secretion by RA-FLSs. Meanwhile, RANKL/OPG ratio was downregulated (Figure 1A). STAT6 phosphorylation and OPG upregulation of RA-FLSs by IL-13 can be significantly inhibited by a STAT6 inhibitor (inh.) (Figure 1B). IL-13 receptor α1 (IL-13Rα1) and IL-13 receptor α2 (IL-13Rα2) knockdown can inhibit OPG upregulation by IL-13 in RA-FLSs, indicating that IL-13 can induce OPG secretion in RA-FLSs through IL-13Rα1 and IL-13Rα2 via STAT6 pathway (Figure 1C). 20% conditioned medium of RA-FLSs pretreated by IL-13 can significantly inhibited osteoclast differentiation in vitro. OPG knockdown in RA-FLSs significantly reversed the inhibition, indicating that IL-13 inhibits osteoclastogenesis by upregulating OPG in RA-FLSs (Figure 1D). In collagen-induced arthritis mice, IL-13 injection can reduce bone destruction in the ankle joint. Meanwhile, OPG expression in vemintin positive FLSs was increased (Figure 1E and F).

Figure 1.

Conclusion

IL-13 can inhibit osteoclastogenesis by up-regulating OPG in RA-FLSs through IL-13 receptors via STAT6 pathway, thus ameliorate bone erosion in RA.

References

[1]Schett G, Gravallese E. Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment. Nat Rev Rheumatol 2012;8(11):656-64.

[2]Walsh MC, Choi Y. Biology of the RANKL-RANK-OPG System in Immunity, Bone, and Beyond. Front Immunol 2014;5:511.

[3]Gravallese EM, Harada Y, Wang JT, et al. Identification of cell types responsible for bone resorption in rheumatoid arthritis and juvenile rheumatoid arthritis. Am J Pathol 1998;152(4):943-51.

[4]Ziolkowska M, Kurowska M, Radzikowska A, et al. High levels of osteoprotegerin and soluble receptor activator of nuclear factor kappa B ligand in serum of rheumatoid arthritis patients and their normalization after anti-tumor necrosis factor alpha treatment. Arthritis Rheum 2002;46(7):1744-53.

[5]Tunyogi-Csapo M, Kis-Toth K, Radacs M, et al. Cytokine-controlled RANKL and osteoprotegerin expression by human and mouse synovial fibroblasts: fibroblast-mediated pathologic bone resorption. Arthritis Rheum 2008;58(8):2397-408.

[6]Raza K, Falciani F, Curnow SJ, et al. Early rheumatoid arthritis is characterized by a distinct and transient synovial fluid cytokine profile of T cell and stromal cell origin. Arthritis Res Ther 2005;7(4):R784-95.

[7]Woods JM, Amin MA, Katschke KJ, Jr., et al. Interleukin-13 gene therapy reduces inflammation, vascularization, and bony destruction in rat adjuvant-induced arthritis. Hum Gene Ther 2002;13(3):381-93.

Acknowledgements

This study was supported by the National Natural Science Foundation of China (grant number 81671608). We would like to thank Prof. Zhihong Xu and Dr. Minghui Sun for the assistance in synovial tissue collection, and all the patients and participants for their support for our study.

Disclosure of Interests

None declared.

AB0096 MECHANISM OF SHIP IN NEUTROPHIL EXTRACELLULAR TRAP IN RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis（RA） is a common autoimmune disease with unknown etiology. RA is characterized by the destruction of cartilage and bone. Neutrophils are abundant in synovial fluid of RA and are closely related to the development of RA 1。In recent years, it has been reported that neutrophils can release neutrophil extracellular traps（NET）, which can not only kill different bacteria and viruses, but also closely related to autoimmune diseases 1,2 Studies have shown that NET is involved in the development of RA3. The Src homologous 2 domain containing inositol 5-phosphatase 1 (SHIP-1) controls the level of intracellular inositol 3-phosphate kinase product phosphatidylinositol-3,4,5-triphosphate. SHIP can be used as a positive or negative regulatory signal in different stimuli.And So has studied that the inflammation of CIA mouse model is reduced after SHIP is inhibited.

Objectives

Therefore, we want to study whether SHIP is involved in the formation of rheumatoid arthritis NET and its relationship with NET.

Methods

We isolated neutrophils from RA peripheral blood, stimulated NETosis with PMA, and detected the changes of NETosis in the group with SHIP inhibitor by flow cytometry and immunofluorescence. In addition, DBA mice were divided into three groups: HC, CIA and SHIP inhibitor intraperitoneal injection group. The degree of paw swelling and HE staining were used to detect the inflammation of mice, and the release of NET in CIA model was detected by flow cytometry.

Results

In the DBA model, the generation of neutrophil extracellular traps decreased significantly in the intraperitoneal injection group of SHIP inhibitor. SHIP inhibitor can significantly inhibit the formation of NET in RA patients. In addition, we also found TNF- α Monoclonal antibodies reduced NETosis in RA patients, while SHIP inhibitors inhibited the generation of NET in RA patients. The results suggest that SHIP may inhibit the inflammatory factor TNF- α. In turn, it is involved in the release of NET in rheumatoid arthritis

Conclusion

SHIP participates in the formation of NET in rheumatoid arthritis and affects the production of NET through pro-inflammatory cytokines. Therefore, SHIP is expected to become a new target for the treatment of RA.

References

[1]Skopelja-Gardner, S.; Jones, J. D.; Rigby, W. F. C. “NETtling” the Host: Breaking of Tolerance in Chronic Inflammation and Chronic Infection. J. Autoimmun.2018, 88, 1–10. https://doi.org/10.1016/j.jaut.2017.10.008.

[2]Lee, K. H.; Kronbichler, A.; Park, D. D.-Y.; Park, Y.; Moon, H.; Kim, H.; Choi, J. H.; Choi, Y.; Shim, S.; Lyu, I. S.; Yun, B. H.; Han, Y.; Lee, D.; Lee, S. Y.; Yoo, B. H.; Lee, K. H.; Kim, T. L.; Kim, H.; Shim, J. S.; Nam, W.; So, H.; Choi, S.; Lee, S.; Shin, J. I. Neutrophil Extracellular Traps (NETs) in Autoimmune Diseases: A Comprehensive Review. Autoimmun. Rev.2017, 16 (11), 1160–1173. https://doi.org/10.1016/j.autrev.2017.09.012.

[3]Khandpur, R.; Carmona-Rivera, C.; Vivekanandan-Giri, A.; Gizinski, A.; Yalavarthi, S.; Knight, J. S.; Friday, S.; Li, S.; Patel, R. M.; Subramanian, V.; Thompson, P.; Chen, P.; Fox, D. A.; Pennathur, S.; Kaplan, M. J. NETs Are a Source of Citrullinated Autoantigens and Stimulate Inflammatory Responses in Rheumatoid Arthritis. Sci. Transl. Med.2013, 5 (178), 178ra40-178ra40. https://doi.org/10.1126/scitranslmed.3005580.

Disclosure of Interests

None declared

Bactericidal efficacy of low concentration of vaporized hydrogen peroxide with validation in a BSL-3 laboratory

BACKGROUND

Highly infective pathogens are cultured and studied in biosafety laboratories. It is critical to thoroughly disinfect these laboratories to prevent laboratory infection. A whole-room, non-contact, reduced corrosion disinfection strategy using hydrogen peroxide was proposed and evaluated.

AIM

To evaluate the bactericidal efficacy of 8% and 10% vaporized hydrogen peroxide( VHP) in a laboratory setting with spores and bacteria as bioindicators.

METHODS

Spores of B. atrophaeus and B. stearothermophilus, along with bacteria E. coli, S. aureus, and S. epidermidis were placed in pre-selected locations in a sealed laboratory and an OXY-PHARM NOCOSPRAY2 vaporized hydrogen peroxide generator was applied. Spore killing efficacy was qualitatively evaluated, and bactericidal efficacy was quantitatively analyzed, and the mean log10 reduction was determined. Finally, the optimized disinfection strategy was verified in a BSL-3 laboratory.

FINDINGS

Significant reductions in microbial load were obtained for each of the selected spores and bacteria when exposed to VHP in concentrations of 8% and 10% for 2～3 h. S. aureus was found to be more resistant than E. coli and S. epidermidis. Tests with 8% hydrogen peroxide and exposure for more than 3 h completely killed B. atrophaeus on surfaces and equipment in the BSL-3 laboratory.

CONCLUSION

The vaporized hydrogen peroxide generator is superior in terms of good diffusivity and low corrosiveness and is time-effective in removing the disinfectant residue. This study provides reference for the precise disinfection of air and object surfaces in biosafety laboratories under varying conditions.

Toripalimab plus chemotherapy in treatment-naïve, advanced esophageal squamous cell carcinoma (JUPITER-06): A multi-center phase 3 trial

Platinum-based chemotherapy is the standard first-line treatment for advanced esophageal squamous cell carcinoma (ESCC). In this phase 3 study (ClinicalTrial.gov: NCT03829969), 514 patients with treatment-naïve advanced ESCC were randomized (1:1) to receive toripalimab or placebo in combination with paclitaxel plus cisplatin (TP) every 3 weeks for up to 6 cycles, followed by toripalimab or placebo maintenance. At the prespecified final analysis of progression-free survival (PFS), a significant improvement in PFS is observed for the toripalimab arm over the placebo arm (hazard ratio [HR] = 0.58; 95% CI, 0.46-0.74; p < 0.0001). The prespecified interim analysis of overall survival (OS) also reveals a significant OS improvement for patients treated with toripalimab plus TP over placebo plus TP (HR = 0.58; 95% CI, 0.43-0.78; p = 0.0004). The incidences of grade ≥3 treatment-emergent adverse events are similar between the two arms. Toripalimab plus TP significantly improves PFS and OS in patients with treatment-naïve, advanced ESCC, with a manageable safety profile.

Toripalimab plus axitinib in patients with metastatic mucosal melanoma: 3-year survival update and biomarker analysis

BACKGROUND

Mucosal melanoma is an aggressive melanoma subtype with poor response to antiprogrammed cell death-1 (PD-1) monotherapy. Axitinib in combination with toripalimab, a humanized IgG4 mAb against PD-1, showed a promising response rate in patients with metastatic mucosal melanoma (MM) in a phase Ib study. Here, we report the updated overall survival (OS), duration of response (DoR), and biomarker analysis results.

METHODS

Patients with advanced MM received toripalimab 1 or 3 mg/kg intravenously every 2 weeks combined with axitinib 5 mg orally two times per day until disease progression or unacceptable toxicity. Tumor programmed cell death ligand-1 (PD-L1) expression, tumor mutational burden (TMB), and gene expression profile (GEP) by messenger RNA sequencing were evaluated for correlation with survival.

RESULTS

As of April 2, 2021, the median follow-up was 42.5 months. Among 29 chemotherapy-naïve patients with metastatic MM, the median OS was 20.7 months (95% CI 9.7 to 32.7 months); the median progression-free survival (PFS) was 7.5 months (95% CI 3.8 to 14.8 months); and the median DoR was 13.4 months (95% CI 5.5 to 20.6 months). The OS rates of 1, 2, and 3 years were 62.1%, 44.8%, and 31.0%, respectively. Biomarker analysis found that PD-L1 expression and TMB level were not associated with survival benefits. In contrast, a 12-GEP signature correlated with improved PFS (17.7 vs 5.7 months, p=0.0083) and OS (35.6 vs 17.6 months, p=0.039).

CONCLUSIONS

The 3-year survival update confirmed the antitumor activity and long-term survival benefit of the toripalimab plus axitinib combination in patients with advanced MM. The 12-gene GEP is of value in predicting the outcomes of vascular endothelial growth factor receptor-tyrosine kinase inhibitor and PD-1 blockade combination therapy, but requires further validation.

TRIAL REGISTRATION NUMBERS

NCT03086174.

Economic burden of public health care and hospitalisation associated with COVID-19 in China

OBJECTIVES

This study aimed to evaluate the socio-economic burden imposed on the Chinese healthcare system during the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN

A cross-sectional study was used to investigate how COVID-19 impacted health and medical costs in China. Data were derived from a subdivision of the Centers for Disease control and Prevention of China.

METHODS

We prospectively collected information from the Centers for Disease Control and Prevention and the designated hospitals to determine the cost of public health care and hospitalisation due to COVID-19. We estimated the resource use and direct medical costs associated with public health.

RESULTS

The average costs, per case, for specimen collection and nucleic acid testing (NAT [specifically, polymerase chain reaction {PCR}]) in low-risk populations were $29.49 and $53.44, respectively; however, the average cost of NAT in high-risk populations was $297.94 per capita. The average costs per 1000 population for epidemiological surveys, disinfectant, health education and centralised isolation were $49.54, $247.01, $90.22 and $543.72, respectively. A single hospitalisation for COVID-19 in China cost a median of $2158.06 ($1961.13-$2325.65) in direct medical costs incurred only during hospitalisation, whereas the total costs associated with hospitalisation of patients with COVID-19 were estimated to have reached nearly $373.20 million in China as of 20, May, 2020. The cost of public health care associated with COVID-19 as of 20, May, 2020 ($6.83 billion) was 18.31 times that of hospitalisation.

CONCLUSIONS

This study highlights the magnitude of resources needed to treat patients with COVID-19 and control the COVID-19 pandemic. Public health measures implemented by the Chinese government have been valuable in reducing the infection rate and may be cost-effective ways to control emerging infectious diseases.

Age and Sex Differences in the Association of Sleep Duration and Overweight/Obesity among Chinese Participants Age above 45 Years: A Cohort Study

OBJECTIVES

We aimed to evaluate the association between sleep duration and obesity and estimate the attributable risk of sleep in the China Health and Retirement Longitudinal Study surveys (CHARLS).

METHODS

A total of 9061 adults aged 45 years above from CHARLS (2011-2015) were included. The main outcome of this study was incident overweight/obesity specific to general and abdominal obesity. Overweight/obesity was defined as BMI ≥ 23.0 (kg/m2) and BMI≥27.5 (kg/m2), respectively. Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. Self-reported sleep durations were obtained using a structured questionnaire. We assessed hazard ratios (HRs) and 95% confidence intervals (CIs) as well as the population attributable fraction (PAF) for associations between sleep duration and obesity.

RESULTS

986 and 606 participants were identified as overweight and general obesity respectively, 1253 experienced abdominal obesity events. In multivariable-adjusted models, participants with daytime sleep of 0-30 minutes and more than 30 minutes associated with 30% (HR: 0.70, 95% CI: 0.56-0.87) and 35% (HR: 0.65, 95% CI: 0.55-0.78) decreased incident overweight risk respectively compared to those having no daytime sleep, this association also found among females and middle-aged, not males or elderly. Similarly, 0-30 minutes (HR: 0.68, 95% CI: 0.48-0.96) and more than 30 minutes of daytime sleep (HR: 0.73, 95% CI: 0.59-0.91) were associated with a reduced risk of abdominal obesity, similar results also found among females and middle-aged. Compared with 7-9 hours of nocturnal sleep, people who slept 5-7 hours had a reduced risk of overweight (HR: 0.59, 95% CI=0.47-0.74),but not found in subgroups. The hazard role of long nocturnal sleep for abdominal obesity was only found among elderly (HR: 2.33, 95% CI=1.35-4.04) and males (HR: 2.24, 95% CI=1.17-4.29). Compared with moderate total sleepers (7-9hours/day), participants with short total sleep duration exhibited an elevated risk of overweight (HR: 1.13, 95% CI=1.00-1.28), this also found among middle-aged. The PAF for inadequate total sleep duration (<7 hours/day) was 10.77% for overweight individuals.

CONCLUSIONS

Insufficient sleep duration was associated with an elevated risk of overweight only detected among middle-aged not elderly and other subgroups specific by age. The risks for abdominal obesity were increased for males and middle-aged with long nocturnal sleep. Daytime sleep may significantly reduce the risk of overweight and abdominal obesity in female and middle-aged individuals. The link between sleep duration and obesity requires further study.

[Clinical applicational comparison of digital impression and silicon rubber impression technique in posterior implant-supported single crown restoration]

Objective: To investigate the clinical effect and satisfaction of partially edentulous patients restored with posterior implant-supported single crown by digital impression technique and traditional silicon rubber impression, in order to provide clinical reference. Methods: Sixty-four partially edentulous patients who visited the Department of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University between March 2018 and January 2021 were enrolled. There were 31 male and 33 female, and the age of the group of patients was (49.3±13.3) years. The 113 implants placed in this group of patients were divided into digital impression group (n=70) and silicone rubber impression group (n=43) according to different impression techniques, and were restored with screw-retained full zirconia single crown, and the patients were followed up for 3-36 months after treatment. The implant survival rate, upper prosthesis, peri-implant soft tissue status, marginal bone loss and patients satisfaction were recorded to evaluate the clinical effects of two impression techniques in posterior implant-supported single crown. Results: In sixty-four patients, digital impression accounted for 62% (40/64), and silicon rubber impression accounted for 38% (24/64), the survival rate of 113 implants was 100% (113/113). The prevalence of interproximal contact loss, food impaction and mechanical complication of the upper full zirconia single crown restorations were 22.7% (41/181), 8.0% (9/113) and 2.7% (3/113) separately. All the mechanical complications were abutment screw loosening. All patients maintained good oral hygiene status, the incidences of peri-implantitis and peri-implant mucositis were 0.9% (1/113) and 4.4% (5/113) respectively. The marginal bone loss was (0.24±0.11) mm. The median of satisfaction visual analogue scale score in patients was 9-10, but no statistically significant differences of all the above results were observed between the two impression techniques (P>0.05). Conclusions: The clinical effect of partially edentulous patients restored with posterior implant-supported single crown using two different impression techniques is good and the satisfaction of patients is high, but the long-term clinical effect remains to be further observed.

Functional characterization of two diacylglycerol acyltransferase 1 genes in Mortierella alpina

Diacylglycerol acyltransferase (DGAT) is a crucial enzyme in the triacylglycerol (TAG) biosynthesis pathway. The oleaginous fungus Mortierella alpina can accumulate large amounts of arachidonic acid (ARA, C20:4) in the form of TAG. Therefore, it is important to study the functional characteristics of its DGAT. Two putative genes MaDGAT1A/1B encoding DGAT1 were identified in M. alpina ATCC 32222 genome by sequence alignment. Sequence alignment with identified DGAT1 homologs showed that MaDGAT1A/1B contain seven conserved motifs that are characteristic of the DGAT1 subfamily. Conserved domain analysis showed that both MaDGAT1A and MaDGAT1B belong to the Membrane-bound O-acyltransferases superfamily. The transforming with MaDGAT1A/1B genes could increase the accumulation of TAG in Saccharomyces cerevisiae to 4·47 and 7·48% of dry cell weight, which was 7·3-fold and 12·3-fold of the control group, respectively, but has no effect on the proportion of fatty acids in TAG. This study showed that MaDGAT1A/1B could effectively promote the accumulation of TAG and therefore may be used in metabolic engineering aimed to increase TAG production of oleaginous fungi.