Cortico-cortical connectivity is influenced by levodopa in tremor-dominant Parkinson's disease

Resting tremor is the most common presenting motor symptom in Parkinson's disease (PD). The supplementary motor area (SMA) is a main target of the basal-ganglia-thalamo-cortical circuit and has direct, facilitatory connections with the primary motor cortex (M1), which is important for the execution of voluntary movement. Dopamine potentially modulates SMA and M1 activity, and both regions have been implicated in resting tremor. This study investigated SMA-M1 connectivity in individuals with PD ON and OFF dopamine medication, and whether SMA-M1 connectivity is implicated in resting tremor. Dual-site transcranial magnetic stimulation was used to measure SMA-M1 connectivity in PD participants ON and OFF levodopa. Resting tremor was measured using electromyography and accelerometry. Stimulating SMA inhibited M1 excitability OFF levodopa, and facilitated M1 excitability ON levodopa. ON medication, SMA-M1 facilitation was significantly associated with smaller tremor than SMA-M1 inhibition. The current findings contribute to our understanding of the neural networks involved in PD which are altered by levodopa medication and provide a neurophysiological basis for the development of interventions to treat resting tremor.

Mouse model of Graves' orbitopathy induced by the immunization with TSHR A and IGF-1R α subunit gene

PURPOSE

The study aimed to establish a mouse model of Graves' disease (GD) with Graves' orbitopathy (GO; GD + GO) that can represent the clinical disease characteristics.

METHODS

A eukaryotic expression plasmid of insulin-like growth factor 1 receptor (IGF-1R) α subunit (pcDNA3.1/IGF-1Rα) and a thyrotropin receptor (TSHR) A subunit plasmid (pcDNA3.1/TSHR-289) were injected in female BALB/c mice followed by immediate electroporation to induce a GD + GO model. Grouping was performed according to the frequency of injection (2- to 4-week intervals) and type of injected plasmids: T: pcDNA3.1/TSHR-289( +), I: pcDNA3.1/IGF-1Rα( +), or co-injection T + I: pcDNA3.1/TSHR-289( +) and pcDNA3.1/IGF-1Rα( +). Serum TSH, T4, TSAb, TSBAb, body weight, and blood glucose levels were evaluated. Thyroid 99mTcO4- imaging and retrobulbar magnetic resonance imaging (MRI) were performed, and bilateral eye muscle volumes were measured. Immunohistochemistry and hematoxylin-eosin staining were performed on the relevant tissues, and semi-quantitative analysis was performed.

RESULTS

A total of 60% of mice (3/5, one mouse died) in the T group developed GD + GO. In the T + I group, 83.3% of mice (5/6) developed GD + GO. Mice in the I group did not develop GD. Compared with the control group, serum T4, TSAb, and TSBAb of the mice in the GD + GO model groups were increased to varying degrees (P < 0.05), and serum TSH and body weight were significantly lower compared to the control group (P < 0.05). The thyroid uptake capacity of 99mTcO4- and the volume of eye muscle of mice in the GD + GO group were significantly higher compared to the control group (P < 0.05). The thyroid and retrobulbar muscles of these mice showed varying inflammatory infiltration and interstitial muscle edema. The severity of GD + GO in the co-injection group was not related to injection frequency; however, GD and ocular signs in co-injection mice were more severe compared to the T group.

CONCLUSIONS

We successfully induced a GD + GO mouse model by a repeated co-injection of pcDNA3.1/IGF-1Rα and pcDNA3.1/TSHR-289 plasmids. Injection of pcDNA3.1/IGF-1Rα alone failed to induce GD. Co-injection of two plasmids induced more severe GD + GO than pcDNA3.1/TSHR-289( +) alone.

[A randomized controlled trial on the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing in the treatment of deep partial-thickness burn wounds in children]

Objective: To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing (hereinafter referred to as foam dressing) in treating the deep partial-thickness burn wounds in children. Methods: This study was a randomized controlled trial. From June 2021 to December 2022, 78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital. According to the random number table, the pediatric patients were divided into two groups, with 38 cases left in combined treatment group (with 20 males and 18 females, aged 26.00 (16.75, 39.75) months) and 39 cases in foam dressing group (with 21 males and 18 females, aged 19.00 (14.00, 31.00) months) after the exclusion of one dropped-out child in follow-up. The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury, the wound was covered with foam dressing after operation, and the dressing was replaced once every 7 days; for the pediatric patients in foam dressing group, the wound was sterilized within 48 hours after injury and covered with foam dressing, and the dressing was replaced once every 2 to 3 days. After the wound healing, the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day, and continuously for over than 6 months. The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC. The adverse reactions during the treatment period, number of dressing changes, and wound healing time were observed and recorded. Six months after wound healing, the Vancouver scar scale (VSS) was used to evaluate the condition of the wound scar. Results: When changing dressing, the FLACC score for pain of pediatric patients in combined treatment group was 3.5 (2.0, 5.0), which was significantly lower than 6.0 (5.0, 8.0) in foam dressing group (Z=-5.40, P<0.05). During the treatment period, no adverse reactions such as wound edema, fluid accumulation, or peripheral skin rash allergies occurred in any pediatric patient in both groups. The number of dressing changes of pediatric patients in combined treatment group was 3 (3, 4) times, which was significantly less than 8 (7, 10) times in foam dressing group (Z=-7.58, P<0.05). The wound healing time of pediatric patients in combined treatment group was (19±5) days, which was significantly shorter than (25±6) days in foam dressing group (t=-4.48, P<0.05). Six months after wound healing, the VSS score for scar of pediatric patients in combined treatment group was 5 (2, 8), which was significantly lower than 7 (5, 10) in foam dressing group (Z=-3.05, P<0.05). Conclusions: Compared with using foam dressings alone, early eschar dermabrasion combined with foam dressings can reduce the number of dressing changes, alleviate the pain during dressing changes, and shorten the wound healing time in treating children with deep partial-thickness burns, and effectively alleviate scar hyperplasia by combining with anti-scar treatment post burns.

Molecular basis of threonine ADP-ribosylation of ubiquitin by bacterial ARTs

Ubiquitination plays essential roles in eukaryotic cellular processes. The effector protein CteC from Chromobacterium violaceum blocks host ubiquitination by mono-ADP-ribosylation of ubiquitin (Ub) at residue T66. However, the structural basis for this modification is unknown. Here we report three crystal structures of CteC in complexes with Ub, NAD+ or ADP-ribosylated Ub, which represent different catalytic states of CteC in the modification. CteC adopts a special 'D-E' catalytic motif for catalysis and binds NAD+ in a half-ligand binding mode. The specific recognition of Ub by CteC is determined by a relatively separate Ub-targeting domain and a long loop L6, not the classic ADP-ribosylating turn-turn loop. Structural analyses with biochemical results reveal that CteC represents a large family of poly (ADP-ribose) polymerase (PARP)-like ADP-ribosyltransferases, which harbors chimeric features from the R-S-E and H-Y-E classes of ADP-ribosyltransferases. The family of CteC-like ADP-ribosyltransferases has a common 'D-E' catalytic consensus and exists extensively in bacteria and eukaryotic microorganisms.

Personalized decision support system for tailoring IgA nephropathy treatment strategies

BACKGROUND

The ongoing debate surrounding the use of immunosuppressive treatments for IgA nephropathy (IgAN) underscores the demand for personalized and effective strategies.

METHODS

Analyzed data from 807 IgAN patients over 5+ years using three methods: Random Forest with molecular biomarkers, network biomarkers with graph engineering, and an auto-encoder model. All models were trained using identical demographic, clinical, and pathological data, employing an 80-20 split for training and testing purposes.

RESULTS

In the comprehensive assessment of IgAN prognosis, the Random Forest model, employing molecular biomarkers, demonstrated strong performance metrics (AUC = 0.83, sensitivity = 0.51, specificity = 0.96). However, traditional graph feature engineering on patient-specific networks outperformed these results with an AUC of 0.90, sensitivity of 0.64, and specificity of 0.94. The Auto-encoder model showed the best accuracy (AUC = 0.91, sensitivity = 0.46, specificity = 0.96). The findings highlighted the superior predictive capabilities of network biomarkers over molecular biomarkers for adverse renal outcome prediction in IgAN. Consequently, we integrated Auto-encoder-derived Network Biomarkers with Random Forest Models to enhance prognostic precision in diverse IgAN treatment scenarios. The prediction for the prognosis of patients receiving supportive care, glucocorticoid therapy, and immunosuppressant treatment yielded AUC values of 0.95, 0.96, and 1, respectively, indicating high specificity. Drawing from these insights, we pioneered the development of an innovative decision support model for IgAN treatment. This model demonstrated the ability to make medical decisions comparable to those by experienced nephrologists, enabling the customization of personalized disease management strategies.

CONCLUSION

Our system accurately predicted IgAN prognosis and evaluated various treatment efficacies, aiding physicians in devising optimal therapeutic strategies for patients.

[Retrospective analysis of 350 cases with dissection of lymph nodes posterior to right recurrent laryngeal nerve in endoscopic thyroidectomy through gasless axillary posterior approach]

Objective: To evaluated the safety and feasibility of dissection of lymph nodes posterior to right recurrent laryngeal nerve (ⅥB compartment) in endoscopic thyroidectomy through gasless axillary posterior approach. Methods: A total of 350 cases with right lobe papillary thyroid carcinoma (PTC) who underwent endoscopic lobectomy, isthmusectomy and central compartment neck dissection via gasless axillary posterior approach based at the Department of General Surgery, Nanfang Hospital, Southern Medical University from June 2020 to December 2022 were retrospectively analyzed. Summarize the clinical, pathological characteristics, and postoperative complications of the patients. SPSS 25.0 was used for statistical analysis of the data. Results: All 350 patients underwent endoscopic surgery successfully, with no conversion to open surgery. There were 303 females and 47 males, with an average age of (36.3±9.2) years. Of those, 287 patients were in pT1a stage, 62 in pT1b stage, and one patient in pT2 stage. There was no T3 or T4 stage patient. The mean numbers of yielded lymph nodes in right central compartment and ⅥB compartment were 8.11±4.65 (range, 1-31) and 2.62±1.86 (range, 1-12), respectively. ⅥB compartment metastasis was detected in 52 (14.86%) of 350 patients. The incidence of transient recurrent laryngeal nerve injury was 0.86%(3/350). Postoperative hematoma occurred in three patients (0.86%). Conclusion: The dissection of ⅥB compartment in endoscopic thyroidectomy through gasless axillary posterior approach is safe and feasible in selected PTC patients.

Identification and functional analysis of circRIPK2 in lipopolysaccharide induced chicken macrophages

1. It was hypothesised that a circular RIPK2 (circRIPK2) highly expressed in chicken macrophages plays an important role during bacterial infection.2. After PCR amplification, Sanger sequencing and RNase R exonuclease treatment of chicken macrophages, it was found that circRIPK2 was a stable circular RNA, which was formed by reverse splicing of exons 4 to 9 of the RIPK2.3. The circRIPK2 can promote the lipopolysaccharide (LPS) induced cellular injury by reducing cell viability and increasing the expression of pro-inflammatory cytokines and apoptosis genes.4. Six miRNAs were identified as interacting with circRIPK2, potentially targeting 1,817 genes, which were significantly enriched in the Wnt signalling pathway, adherens junction and NOD-like receptor signalling pathway.5. This study provides better understanding of the function of circRIPK2, which may prove a potential biomarker and indicate potential targets for the treatment of bacterial infection.

Machine Learned Texture Prior From Full-Dose CT Database via Multi-Modality Feature Selection for Bayesian Reconstruction of Low-Dose CT

In our earlier study, we proposed a regional Markov random field type tissue-specific texture prior from previous full-dose computed tomography (FdCT) scan for current low-dose CT (LdCT) imaging, which showed clinical benefits through task-based evaluation. Nevertheless, two assumptions were made for early study. One assumption is that the center pixel has a linear relationship with its nearby neighbors and the other is previous FdCT scans of the same subject are available. To eliminate the two assumptions, we proposed a database assisted end-to-end LdCT reconstruction framework which includes a deep learning texture prior model and a multi-modality feature based candidate selection model. A convolutional neural network-based texture prior is proposed to eliminate the linear relationship assumption. And for scenarios in which the concerned subject has no previous FdCT scans, we propose to select one proper prior candidate from the FdCT database using multi-modality features. Features from three modalities are used including the subjects' physiological factors, the CT scan protocol, and a novel feature named Lung Mark which is deliberately proposed to reflect the z-axial property of human anatomy. Moreover, a majority vote strategy is designed to overcome the noise effect from LdCT scans. Experimental results showed the effectiveness of Lung Mark. The selection model has accuracy of 84% testing on 1,470 images from 49 subjects. The learned texture prior from FdCT database provided reconstruction comparable to the subjects having corresponding FdCT. This study demonstrated the feasibility of bringing clinically relevant textures from available FdCT database to perform Bayesian reconstruction of any current LdCT scan.

Uric acid-based ratios for predicting renal failure in Chinese IgA nephropathy patients

Objective: The uric acid/albumin ratio (UAR), a novel, simple, and compositive laboratory biomarker, has recently attracted attention for predicting disease prediction and disease prognosis. However, whether uric acid-related biomarkers (especially UAR) could serve as prognostic indicator for IgAN is unclear. Methods: In this retrospective cohort study, biopsy-confirmed IgAN patients from 2009 to 2017 from West China Hospital were evaluated. The optimal cutoff value of UAR for renal outcome was defined using the Youden index by the area under receiver operating characteristic curve (AUC). The patients were then categorized into the high UAR group and the low UAR group. Renal endpoints were defined as progression to ESRD, eGFR decreased ≥50% of the baseline level, or initiation of renal replacement treatment. Kaplan‒Meier survival analysis and Cox regression analysis were used to identify factors influencing IgAN outcomes. Results: A total of 1143 patients with a median age of 33.0 (26.0-42.0) (44.2% men) were included in the study. The best cut-off UAR concerned with renal survival was determined to be 9.94 with a specificity of 77.5% and a sensitivity of 61.5% (J, 0.390; AUC, 0.750). Then, the patients were divided into two groups labelled as low and high UAR ratios (≥ 9.94 and <9.94, respectively). More severe clinical manifestations and pathological lesions were observed in the high UAR group. Multivariate Cox regression analysis after adjusted for important clinicopathological parameters manifested that a high UAR was an independent prognostic biomarker for IgAN. (p = 0.036, HR =2.56, 95% CI: 1.07-6.16). Conclusion: UAR might be a novel predictor for renal progression and contribute to targeted management.

Altered serum metabolic profile in patients with IgA nephropathy

BACKGROUND

We investigated alterations in the serum metabolomic profile of IgA nephropathy (IgAN) patients and screen biomarkers of IgA nephropathy based on ultra-performance liquid chromatography-mass spectrometry (UPLC-MS).

METHODS

Serum samples from 65 IgAN patients and 31 healthy controls were analyzed by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Univariate and multivariate analysis were performed to screen the differential metabolites. Differential metabolites should meet both the following two criteria: adjusted P < 0.05 in the univariate analysis and VIP value > 1 in the multivariate model. Pathway analysis was performed to reveal the metabolic pathways that were significantly influenced in IgAN. Spearman correlation analysis was applied to explore the correlation between metabolites and between the metabolites and clinicopathological features of IgAN. A random forest model and Logistics regression analysis were conducted to evaluate the predictive ability of the metabolites.

RESULTS

The metabolic profile was significantly altered in IgAN patients compared with healthy controls. Thirty-nine metabolites were identified, including glycerophospholipids, sphingolipids, vitamin K1, vitamin K2, bile acids and amino acids. Sphingolipid metabolism, ubiquinone and other terpenoid-quinone biosynthesis, and glycerophospholipid metabolism were found to be significantly disturbed in the pathway analysis. Differential metabolites were found to be associated with the clinical and pathological features of IgAN patients. Lanosterol, vitamin K1, vitamin K2, and β-elemonic acid were found to have promising predictive ability for IgAN.

CONCLUSIONS

We confirmed the differences in the metabolic profiles of IgAN patients and healthy controls and identified the differential metabolites of IgAN, which may help with the further exploration of the pathogenesis and treatment of IgAN.

Roles of mesangial C3 and C1q deposition in the clinical manifestations and prognosis of IgAN

BACKGROUND AND AIM

Immunoglobulin A nephropathy (IgAN) is regarded as the most common type of glomerulonephritis around the world and has the potential to result in renal failure. Complement activation has been addressed by a great body of evidence in the pathogenesis of IgAN. We aimed to evaluate the predictive value of C3 and C1q deposition for disease progression in IgAN patients in this retrospective study.

METHODS

We recruited 1191 biopsy-diagnosed IgAN patients, and they were divided into different groups according to their glomerular immunofluorescence examination of renal biopsy tissues: 1) C3 deposits ≥ 2 + group (N = 518) and C3 deposits < 2 + group (N = 673). 2) C1q deposit-positive group (N = 109) and C1q deposit-negative group (N = 1082). The renal outcomes were end-stage renal disease (ESRD) and/or an estimated glomerular filtration rate (eGFR) decrease greater than 50% from the baseline value. Kaplan-Meier analyses were performed to evaluate renal survival. Univariate and multivariate Cox proportional hazard regression models were used to evaluate the effect of C3 and C1q deposition on renal outcome in IgAN patients. In addition, we compared the predictive value of mesangial C3 and C1q deposition in IgAN patients.

RESULTS

The median follow-up period was 53 months (interquartile range 36-75 months). During follow-up, 7% (84) of patients progressed to ESRD, and 9% (111) of patients had an eGFR decline ≥ 50%. IgAN patients complicated with C3 deposits ≥ 2 + were associated with more severe renal dysfunction and pathologic lesions at the time of renal biopsy. The crude incidence rates for the endpoint were 12.5% (84 out of 673) and 17.2% (89 out of 518) in the C3 < 2 + and C3 ≥ 2 + groups, respectively (P = 0.022). Of C1q deposit-positive and C1q deposit-negative patients, 22.9% (25 out of 109) and 13.7% (148 out of 1082) reached the composite endpoint, respectively (P = 0.009). Adding C3 deposition to clinical and pathologic models had better predictability of renal disease progression than C1q.

CONCLUSION

Glomerular C3 and C1q deposits affected the clinicopathologic features of IgAN patients and emerged as independent predictors and risk factors for renal outcomes. In particular, the predictive ability of C3 was slightly better than that of C1q.

Integrated analysis of mRNA and microRNA expression pattern reveals differential transcriptome signatures in RIPK2 over-expressing chicken macrophages infected with avian pathogenic E. coli

1. As RIPK2 (receptor interacting serine/threonine kinase 2) has been shown to to alleviate excessive inflammatory responses, the following study conducted a systematic and in-depth analysis of the mRNA-seq and miRNA-seq data from chicken macrophages with/without over-expression of RIPK2 (oeRIPK2) combined with/without avian pathogenic E. coli (APEC) infection to identify the miRNA-mRNA interaction network and potential signalling pathways involved.2. A total of 9,201 differentially expressed (DE) mRNAs and 300 DE miRNA were identified in both oeRIPK2+APEC vs. APEC and oeRIPK2 vs. the wild-type (WT). Moreover, 4,269 instances of co-expression between miRNAs and mRNAs were seen involving 1,652 DE mRNAs and 164 DE miRNAs.3. Functional analysis of the DE mRNAs in the miRNA-mRNA interaction network showed that 223 biological processes and five KEGG pathways were significantly enriched in the two comparisons. In total, 128 pairs of miRNA-mRNA interactions were involved in the identified MAPK signalling pathway and focal adhesion immune related pathways.4. Significantly, these screened miRNAs (gga-miR-222b-5p and gga-miR-214) and their target genes were highly correlated with APEC infection and RIPK2. These recognised key genes, miRNA and the overall miRNA-mRNA regulatory network, enables better understanding of the molecular mechanism of host response to APEC infection, especially related to RIPK2.

Regulation of CO2 by the sea in areas around Latin America in a context of climate change

Anthropogenic activities are increasing the atmospheric carbon dioxide (CO₂); around a third of the CO₂ emitted by these activities has been taken up by the ocean. Nevertheless, this marine ecosystem service of regulation remains largely invisible to society, and not enough is known about regional differences and trends in sea-air CO₂ fluxes (FCO2), especially in the Southern Hemisphere. The objectives of this work were as follows: first to put values of FCO2 integrated over the exclusive economic zones (EEZ) of five Latin-American countries (Argentina, Brazil, Mexico, Peru, and Venezuela) into perspective regarding total country-level greenhouse gases (GHG) emissions. Second, to assess the variability of two main biological factors affecting FCO2 at marine ecological time series (METS) in these areas. FCO2 over the EEZs were estimated using the NEMO model, and GHG emissions were taken from reports to the UN Framework Convention on Climate Change. For each METS, the variability in phytoplankton biomass (indexed by chlorophyll-a concentration, Chla) and abundance of different cell sizes (phy-size) were analyzed at two time periods (2000-2015 and 2007-2015). Estimates of FCO2 at the analyzed EEZs showed high variability among each other and non-negligible values in the context of greenhouse gas emissions. The trends observed at the METS indicated, in some cases, an increase in Chla (e.g., EPEA-Argentina) and a decrease in others (e.g., IMARPE-Peru). Evidence of increasing populations of small size-phytoplankton was observed (e.g., EPEA-Argentina, Ensenada-Mexico), which would affect the carbon export to the deep ocean. These results highlight the relevance of ocean health and its ecosystem service of regulation when discussing carbon net emissions and budgets.

Contemporary review of the management of left ventricular thrombus

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI) and other cardiomyopathies. LVT increases the risk of stroke and systemic embolism, hence treatment with oral anticoagulation is indicated. While the initial treatment options for LVT is clear, the management of patients after the initial duration of anticoagulation is more complex and varied.

Purpose

We aimed to undertake a comprehensive literature review to study the currently available evidence regarding not only the initial type and duration of anticoagulation for LVT, but also potential treatment options after the initial period of anticoagulation in the setting of both LVT persistence and resolution.

Methods

MEDLINE, EMBASE, Scopus, and Google Scholar were searched from inception to August 2022. Data from randomized controlled trials (RCTs), observational studies and case series discussing management of LVT were included in this summarized synthesis.

Results

Of 2050 studies screened, 30 studies (24 observational studies, 3 case series, 2 RCTs, 1 non-randomized, open-label trial) were included. A total of 17 studies compared warfarin with direct oral anticoagulants (DOACs) for the initial anticoagulation strategy, with the vast majority showing similar outcomes (Table 1). Half (n = 9/18) of the studies repeated imaging between 3-6 months. All studies (n=30) used transthoracic echo with or without contrast as the imaging modality of choice, with selected patients undergoing computed tomography (CT) or cardiac magnetic resonance (CMR). If the LVT persisted, most studies recommended continuing anticoagulation (n = 11/16, 69%) or switching to a different class of anticoagulants (n = 6/16, 38%). In the event of LVT non-resolution, high-risk features of embolization (protruding, mobile vs layered clot) may aid in the discussion of risk and benefit of long-term anticoagulation. Even upon resolution of the LVT, some studies (n=5) recommend continuing anticoagulation in the presence of high-risk features of recurrence (eg. persistently depressed left ventricle ejection fraction (LVEF) and/or apical wall dyskinesis). Regardless, medical management should be optimized together with the appropriate revascularization strategy as clinically indicated.

Conclusions

Current evidence on the management of LVT is limited. This updated review summarizes the available evidence for the management for LVT. Evidence-based recommendations on the management of these patients is warranted to appropriately guide clinicians.

End-stage kidney disease in Brunei Darussalam (2011-2020)

INTRODUCTION

The Brunei Dialysis and Transplant Registry (BDTR) recorded data on patients with end-stage kidney disease (ESKD) from 2011 to 2020, mainly for planning of services and benchmarking of standards. We report the trends of epidemiologic and performance parameters, compare performances between modalities of Kidney Replacement Therapy and evaluate the survival of ESKD patients over the 10-year period.

MATERIALS AND METHODS

Three groups of data were analysed from the BDTR over the 10-year period. Epidemiological data, blood parameters and dialysis are key performance indicators.

RESULTS

There are increments in prevalence and incidence of treated ESKD patients in Brunei over 10 years, especially with haemodialysis (HD). The projected prevalence and incidence showed an anticipated annual increase of 42.2 per million population (pmp) and 9.9 pmp respectively. Diabetes mellitus (DM) (79%) was the main cause of ESKD. HD (86%), peritoneal dialysis (PD) (9%) and transplant (5%) were the main modalities of kidney replacement therapy in 2020. Cumulative results over the decade showed significant improvements in serum phosphate, peritonitis rates and HD blood flow rates. PD patients have better survival rates, lower systolic blood pressure and better adequacy. PD survival (patient survival of 91%, 73% and 56% at 1, 3 and 5 years respectively) was superior to HD survival (86% and 64% at 1 and 2 years, respectively), but patient demographics (age and DM status) were different. The 2020 dataset showed satisfactory anaemia management but mineral bone disease management was sub-optimal. Seventy percent of prevalent HD patients had arteriovenous fistula access. Thirty-two percent and fifty-two percent of HD and PD patients, respectively, achieved target dialysis adequacy. Peritonitis rate was 0.3 episodes per patient year.

CONCLUSION

Brunei has a high incidence and prevalence of treated ESKD in the last decade, especially DM-related ESKD. This study has identified many specific areas to be targeted for improvements and provided evidence for further proliferation of PD and transplant preference policy.

The KNee OsteoArthritis Prediction (KNOAP2020) challenge: An image analysis challenge to predict incident symptomatic radiographic knee osteoarthritis from MRI and X-ray images

OBJECTIVES

The KNee OsteoArthritis Prediction (KNOAP2020) challenge was organized to objectively compare methods for the prediction of incident symptomatic radiographic knee osteoarthritis within 78 months on a test set with blinded ground truth.

DESIGN

The challenge participants were free to use any available data sources to train their models. A test set of 423 knees from the Prevention of Knee Osteoarthritis in Overweight Females (PROOF) study consisting of magnetic resonance imaging (MRI) and X-ray image data along with clinical risk factors at baseline was made available to all challenge participants. The ground truth outcomes, i.e., which knees developed incident symptomatic radiographic knee osteoarthritis (according to the combined ACR criteria) within 78 months, were not provided to the participants. To assess the performance of the submitted models, we used the area under the receiver operating characteristic curve (ROCAUC) and balanced accuracy (BACC).

RESULTS

Seven teams submitted 23 entries in total. A majority of the algorithms were trained on data from the Osteoarthritis Initiative. The model with the highest ROCAUC (0.64 (95% confidence interval (CI): 0.57-0.70)) used deep learning to extract information from X-ray images combined with clinical variables. The model with the highest BACC (0.59 (95% CI: 0.52-0.65)) ensembled three different models that used automatically extracted X-ray and MRI features along with clinical variables.

CONCLUSION

The KNOAP2020 challenge established a benchmark for predicting incident symptomatic radiographic knee osteoarthritis. Accurate prediction of incident symptomatic radiographic knee osteoarthritis is a complex and still unsolved problem requiring additional investigation.

Association of obesity with the development of end stage renal disease in IgA nephropathy patients

BACKGROUND AND AIM

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. We aimed to evaluate whether obesity is a risk factor for IgAN patients.

METHODS

A total of 1054 biopsy-proven IgAN patients were analyzed in this retrospective study. Patients were divided into four groups according to their body weight index (BMI) at the period of renal biopsy: underweight group (BMI< 18.5, N=75), normal weight group (18.5≤BMI<24, N=587), overweight group (24≤BMI<28, N=291) and obesity group (28≤BMI, N=101). The endpoint of our study was end stage renal disease (ESRD: eGFR <15 mL/min/1.73 m² or having renal replacement treatment). Kaplan-Meier analyses and Cox proportional hazard models were performed to evaluate renal survival. Propensity-score matching (PSM) was performed to get the matched cohort to evaluate the role of obesity in IgAN patients. Besides, the effect modification of obesity and hypertension in IgAN patients was clarified by the synergy index.

RESULTS

IgAN patients complicated with obesity had more severe renal dysfunction at the time of renal biopsy than those with optimal body weight. In addition, patients with obesity tended to have higher risk of metabolic disorders, such as hyperuricemia (64.4% vs 37%, p<0.001), hypertriglyceridemia (71.3% vs 32.5%, p<0.001) and hypercholesterolemia (46.5% vs 35.6%, p=0.036). It was observed that obesity patients had higher rate of unhealthy behaviors, such as smoking (27.7% vs 16.4%, p=0.006) and alcohol drinking (29.7% vs 19.9%, p=0.027). Although obesity was not confirmed as an independent risk factor for IgAN patients, we found that IgAN patients with obesity presented with higher incidence of hypertension, as well as lower event-free renal survival rate (log-rank p < 0.001), especially in patients with 24-h urine protein ≥ 1g (log-rank p =0.002). In addition, the synergy index showed that there was positive interaction between obesity and hypertension in IgAN.

CONCLUSION

Obesity is an important risk factor for IgAN patients when combined with hypertension. Hypertension appears to be common in obese IgAN patients.

Clinicopathological characteristics and risk factors in elderly patients with biopsy-proven IgA nephropathy

BACKGROUND

Immunoglobulin A nephropathy (IgAN) has been well studied among young people, but few data on clinicopathological characteristics, treatment response and outcomes for elderly IgAN patients are available.

METHODS

A cohort study of elderly IgAN patients was performed. The combined endpoints of renal outcome were a 50% decline in eGFR compared with the time of renal biopsy, end-stage kidney disease and/or death. Risk factors associated with poor renal outcomes were then determined. The benefits of immunosuppressant therapies were also evaluated by Kaplan-Meier survival curve analysis.

RESULTS

This study ultimately included 126 elderly patients with IgAN. Comparison between the endpoint and non-endpoint groups indicated that patients with poor outcomes had more severe clinical features, such as worse kidney function, severe hematuria and lower albumin levels. Cox regression analysis indicated that age (HR 1.15, 95% CI 1.02-1.29, p = 0.021), male gender (HR 9.71, 95% CI 1.00-97.56, p = 0.050), and urine red blood cells (HR 1.003, 95% CI 1.000-1.006, p = 0.029) were independent risk factors for poor renal outcome in elderly IgAN patients. To explore possible reasons accounting for the predictive value of age and sex, patients were divided into two groups based on these two variables. Patients in the geriatric group had lower serum albumin, estimated glomerular filtration rate, hemoglobin and aspartate aminotransferase levels than those in the quinquagenarian group. Male patients tended to have higher hemoglobin, higher alanine aminotransferase, and lower triglycerides and cholesterol levels than female patients. To investigate different treatment responses, patients were classified into two groups depending on treatment strategies (renin-angiotensin system inhibitors and immunosuppressive therapy), and the survival analysis indicated no significant difference in kidney outcome between the two groups (p > 0.05). This result still holds after adjusting for age, sex, eGFR, hematuria, and proteinuria.

CONCLUSION

Advanced age, male, and hematuria might be independently associated with poor kidney outcomes in elderly patients with IgAN. Immunosuppressive therapy might confer no overall benefit to older IgAN patients.

Oral energy supplementation improves nutritional status in hemodialysis patients with protein-energy wasting: A pilot study

Background: Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients, which is associated with poor quality of life, complications, and an increased risk of mortality. A prospective study in HD patients with 2 months of oral energy supplements (OESs) was performed. Methods: A total of 37 HD patients with PEW were finally enrolled in this prospective study and were randomized into the OES group (n = 19), which received oral energy supplementation (300 kcal) and dietary recommendations, while patients in the non-OES group (n = 18) received only dietary recommendations. The study duration was 2 months. The nutritional status of the patients was evaluated by laboratory indexes, body composition parameters, and the modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS). Quality of life was evaluated by the Short Form Health Survey Questionnaire (SF-36). Results: After 2 months of therapy, a significant increase in serum albumin [39.6 (37.6-45.8) vs. 43.4 (39.1-46.7) g/L; p = 0.018], hemoglobin (101.0 ± 13.6 g/L vs. 111.8 ± 11.7 g/L; p = 0.042), and dietary energy intake (29.17 ± 3.22 kcal/kg/day vs. 33.60 ± 2.72 kcal/kg/day, p < 0.001) was observed in the comparisons of baseline in the OES group. Moreover, the OES group demonstrated significant amelioration in MQSGA [9 (8-13) vs. 8 (7-12), p < 0.001] and MIS [5 (3-10) vs. 3 (2-8), p < 0.001], physical functioning (p < 0.001), and mental health (p = 0.046) subsections of SF-36 compared with the baseline. No electrolyte disorders or dyslipidemia were observed in the OES group. Conclusion: OES in HD patients with PEW can significantly ameliorate energy supply, nutritional status, anemia, and quality of life.

[Effects of composite laser technique combined with multipoint microinjection of triamcinolone acetonide in the treatment of hypertrophic scars in burn children]

Objective: To explore the effects of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children. Methods: A retrospective cohort before-after control study in the same patients was conducted. From February 2019 to December 2020, a total of 67 burn children who met the inclusion criteria (32 males and 35 females, aged 1 to 12 years) with red hyperplastic scar at early stage, were treated in Hunan Provincial People's Hospital (1st Affiliated Hospital of Hunan Normal University). All the children were treated with composite laser technique (PDL and UFCL) combined with triamcinolone acetonide (hereinafter referred to as combined treatment). After 2 months, they received the second combined treatment. Before the first combined treatment and 6 months after the last combined treatment, the scar of children was evaluated with the patient and observer scar assessment scale (POSAS) by physicians and family members. Six months after the last combined treatment, the satisfaction of the patients' family members with the efficacy was recorded and the overall satisfaction rate was calculated. Adverse reactions were recorded throughout the treatment process. Data were statistically analyzed with paired sample t test. Results: Six months after the last combined treatment, the POSAS scores of children on the thickness, blood vessels distribution, color, surface roughness, texture, scope, and overall evaluation of scar evaluated by the physicians, and the POSAS scores of children on the color, degree of pain, degree of itching, hardness, thickness, shape and size, and overall evaluation of scar evaluated by the family members were significantly lower than those before the first combined treatment (with t values of 17.32, 16.73, 15.00, 14.91, 19.62, 28.74, 29.83, 17.43, 20.52, 29.01, 28.82, 24.91, 20.30, and 42.13, respectively, P<0.01). Six months after the last combined treatment, 62 (93%), 3 (4%), and 2 (3%) children's family members were very satisfied, satisfied, and relatively satisfied with the treatment effect, respectively, and the overall satisfaction rate was 97% (65/67). Six months after the last combined treatment, no scar thickening or infection occurred in all the wounds of children. Conclusions: Composite laser technique combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children can improve the appearance and texture of scar, reduce scar pain and pruritus, with high satisfaction of children's family members to the treatment effect and less adverse reactions.

Effectiveness of Microecological Preparations for Improving Renal Function and Metabolic Profiles in Patients With Chronic Kidney Disease

Background

Determining whether microecological preparations, including probiotics, prebiotics, and synbiotics, are beneficial for patients with chronic kidney disease (CKD) has been debated. Moreover, determining which preparation has the best effect remains unclear. In this study, we performed a network meta-analysis of randomized clinical trials (RCTs) to address these questions.

Methods

MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were searched. Eligible RCTs with patients with CKD who received intervention measures involving probiotics, prebiotics, and/or synbiotics were included. The outcome indicators included changes in renal function, lipid profiles, inflammatory factors, and oxidative stress factors.

Results

Twenty-eight RCTs with 1,373 patients were ultimately included. Probiotics showed greater effect in lowering serum creatinine [mean difference (MD) −0.21, 95% confidence interval (CI) −0.34, −0.09] and triglycerides (MD −9.98, 95% CI −19.47, −0.49) than the placebo, with the largest surface area under the cumulative ranking curve, while prebiotics and synbiotics showed no advantages. Probiotics were also able to reduce malondialdehyde (MDA) (MD −0.54, 95% CI −0.96, −0.13) and increase glutathione (MD 72.86, 95% CI 25.44, 120.29). Prebiotics showed greater efficacy in decreasing high-sensitivity C-reactive protein (MD −2.06, 95% CI −3.79, −0.32) and tumor necrosis factor-α (MD −2.65, 95% CI −3.91, −1.39). Synbiotics showed a partially synergistic function in reducing MDA (MD −0.66, 95% CI −1.23, −0.09) and high-sensitivity C-reactive protein (MD −2.01, 95% CI −3.87, −0.16) and increasing total antioxidant capacity (MD 145.20, 95% CI 9.32, 281.08).

Conclusion

The results indicated that microbial supplements improved renal function and lipid profiles and favorably affected measures of oxidative stress and inflammation in patients with CKD. After thorough consideration, probiotics provide the most comprehensive and beneficial effects for patients with CKD and might be used as the best choice for microecological preparations.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022295497, PROSPERO 2022, identifier: CRD42022295497.

Probiotics ameliorate IgA nephropathy by improving gut dysbiosis and blunting NLRP3 signaling

Background

Recently, a few studies have indicated a relationship between the gut microbiota and IgA nephropathy (IgAN). Whether the gut microbiota participates in the pathogenesis of IgAN and whether probiotics are effective in treating IgAN are still controversial. Therefore, this study aimed to identify the differences in the structure of the gut microbiota between IgAN and controls and to evaluate the efficacy and mechanism of probiotics in the treatment of IgAN.

Methods

To address this question, 35 IgAN patients and 25 healthy volunteers were enrolled, and a mouse IgAN model was also constructed. The stool microbes were analyzed by 16S rRNA high-throughput sequencing to identify the differential strains between IgAN and healthy controls. The impact of probiotics on the structure of the intestinal flora and the efficacy of the probiotics in the treatment of IgAN were evaluated.

Results

Although the microflora structure of mice and humans was not the same, both patients and mice with IgAN exhibited gut microbiota dysbiosis, with all subjects presenting an evident decrease in Bifidobacterium levels. The Bifidobacterium proportion was negatively correlated with proteinuria and hematuria levels, indicating that the decreased Bifidobacterium abundance could be related to IgAN severity. Probiotic treatment containing Bifidobacterium in IgAN mice could significantly alleviate gut dysbiosis, specifically by increasing the proportion of beneficial bacteria and reducing the abundance of potentially pathogenic bacteria. Moreover, both probiotics and their metabolites, short-chain fatty acids (SCFAs), could attenuate IgAN clinicopathological manifestations by inhibiting the NLRP3/ASC/Caspase 1 signaling pathway.

Conclusions

Supplementation with probiotics mainly containing Bifidobacterium could markedly improve gut dysbiosis in IgAN. Moreover, both probiotics and their SCFA metabolites could attenuate the clinicopathological manifestations of IgAN by inhibiting the NLRP3/ASC/Caspase 1 signaling pathway. Therefore, probiotics have potential as an adjunctive therapy for IgAN.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-022-03585-3.

Emerging trends and focus for the link between the gastrointestinal microbiome and kidney disease

The clinical value of the relationship between gastrointestinal microbiome imbalance and its corresponding interventions with kidney disease is emerging. This study describes the hotspots and evolution of gastrointestinal microbiome and kidney disease research over the past three decades by scientific collaboration networks and finally predicts future trends in the field through bibliometric analysis and visualization studies. CiteSpace was used to explore the original articles from January 1990 to August 2021 to visualize the knowledge network of journals, countries, institutions, authors, references, and keywords in this field. Publications were extracted from Web of Science Core Collection database using the terms “gastrointestinal microbiome” and “kidney disease” (and their synonyms in MeSH). A total of 2145 publications with 93880 references in 102 journals were included in the analyses. The number of studies combining gastrointestinal microbiomes with kidney diseases has increased significantly over the past two decades. The United States is the leading country in the number of documents, and the leading institution is the Cleveland Clinic. The most landmark articles in the field are on chronic renal failure, L-Carnitin, and cardiovascular disease. The pathogenesis of uremia toxin is an emerging trend in gastrointestinal microbiomes and kidney diseases. In addition, probiotic or synbiotic supplements have strong clinical value in adjusting abnormal intestinal symbiotic environments. This study demonstrates a growing understanding of the interaction between gut microbiota and kidney disease over time. Using microbial supplements to improve the living conditions of kidney disease patients is a promising and hot research focus. Based on publications extracted from the database, this study may provide clinicians and researchers with valuable information to identify potential collaborators and partner institutions and better predict their dynamic progression.

Efficacy and safety of potassium binders in the treatment of patients with chronic kidney disease and hyperkalemia

BACKGROUND

Gastrointestinal cation exchangers that can bind potassium in the gut, including sodium polystyrene sulfonate (SPS), calcium polystyrene sulfonate (CPS), patiromer and sodium zirconium cyclosilicate (SZC), are emerging medications for the treatment of hyperkalemia with chronic kidney disease (CKD). However, which might be the best alternative for patients with chronic kidney disease and hyperkalemia remains disputed.

METHODS

We performed this systematic review and network meta-analysis with the Bayesian approach to conduct direct and indirect comparisons among potassium binders regarding their efficacy and safety. The surface under the cumulative ranking curve analysis (SUCRA) was used to calculate the best intervention for each outcome.

RESULTS

All four potassium binders had a promising effect regarding potassium reduction. SPS had favorable efficacy and safety for short-term use (MD: -0.94; 95% CIs: -1.4 to -0.48; SUCRA = 94.69%), but long-term treatment required strict dose control and assessment of gastrointestinal conditions. CPS had a positive effect on reducing potassium, and could especially maintain the serum potassium concentration in patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi). Patiromer might reduce all-cause mortality in CKD patients with hyperkalemia and have a positive effect on potassium-lowering, though it had significant gastrointestinal adverse effects. SZC had a potassium-lowering effect in both the short-term and long-term, and can be a promising long-term treatment for the hyperkalemia in CKD patients, especially in combination with RAASi.

CONCLUSION

These four potassium binders had their own advantages and disadvantages, and the medication should be selected according to the clinical situation of the patient.

Prognostic Value of Triglyceride to High-Density Lipoprotein Cholesterol Ratio (TG/HDL-C) in IgA Nephropathy Patients

Background

The triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio is an easy-to-use atherogenic and prognostic marker which has attracted increasing attention these days. However, whether TG/HDL-C correlate with outcomes in IgA nephropathy (IgAN) patients remains unknown. To clarify these issues, we conducted this study.

Methods

A total of 1146 patients from West China Hospital of Sichuan University were retrospectively analysed between 2008 and 2018.The demographic, clinical and pathological data of all patients at the time of biopsy were collected. Then, patients were divided into the high TG/HDL group (TG/HDL ≥ 1.495, N=382) and the low TG/HDL group (TG/HDL-C < 1.495, N=764) based on the optimal cut-off value of the TG/HDL-C using receive operating curve. Cox proportional hazard models and Kaplan-Meier curves were used to evaluate the renal outcomes of IgAN.

Results

The median age of the patients was 33 (26-42) years, and 44.5% were men. By correlation analysis, we found that the TG/HDL-C ratio was negatively correlated with the eGFR (r = 0.250, P < 0.001) but positively correlated with proteinuria (r = 0.230, P< 0.001), BMI (r=0.380, P<0.001) and serum uric (r =0.308, P< 0.001). Patients with a higher TG/HDL-C ratio tended to have hypertension [odds ratio (OR), 1.987; 95% CI, 1.527-2.587; P<0.001] and more severe pathologic lesions with tubular atrophy/interstitial fibrosis (OR, 1.610; 95% CI, 1.203-2.154; P=0.001). During a median follow-up period of 54.1 (35.6-73.2) months, a high TG/HDL ratio was strongly associated with worse renal survival in IgAN patients (log-rank: P <0.001). Multivariate Cox analysis demonstrated that a high TG/HDL-C ratio (HR 1.775, 95% CI 1.056-2.798; P=0.029) was an independent predictive marker to ESRD.

Conclusion

In this study, we addressed the importance of TG/HDL-C ratio as a predictive marker for IgAN progression.

Platelet-to-Albumin Ratio: A Novel IgA Nephropathy Prognosis Predictor

Background

Chronic inflammation is related to the development of IgA nephropathy (IgAN). Emerging studies have reported that platelet-related parameters including platelet (PLT), platelet-to-albumin ratio (PAR), and platelet-to-lymphocyte ratio (PLR) are proved to be novel prognostic indicators for several inflammatory diseases. Whether platelet-related parameters could serve as predictors for IgAN remains unknown.

Methods

A total of 966 IgAN patients were enrolled in this retrospective study and were divided into several groups based on the optimal cut-off value of the platelet-related parameters. End-stage renal disease was used as the renal endpoint. A 1:2 propensity score (PS) match was then carried out to eliminate significant differences at baseline. The area under the receiver operating characteristic curve (AUROC), Kaplan–Meier (K-M) curve, and Cox proportional hazards analyses were performed to evaluate their predictive effect.

Results

Without considering the effect of covariates, the K-M curve showed that PLT, PLR, and PAR were strongly correlated with the renal outcomes of IgAN. However, the AUROC revealed that the PAR and PLR had better predictive power than the PLT. Multivariate Cox regression adjusting for demographic data, pathological findings, treatment, and laboratory results indicated that compared with PLR, albumin and PLT, PAR seemed to be a better marker of adverse renal outcome, implying that PAR was the only platelet-related parameter that could be used as an independent risk factor. Notably, high PAR patients seemed to have more severe clinical manifestations and pathological lesions. However, after eliminating the influence of different baselines on outcome variables, the PAR could still predict the poor prognosis of IgAN. To more accurately evaluate the predictive power of the PAR, we analyzed the predictive effect of the PAR on patients with different clinicopathological characteristics through subgroup analysis. It was indicated that the PAR might better predict the prognosis and outcome of patients whose disease was already very severe.

Conclusion

PAR might be used as an independent risk factor for IgAN progression.

35B5 antibody potently neutralizes SARS-CoV-2 Omicron by disrupting the N-glycan switch via a conserved spike epitope

The SARS-CoV-2 Omicron variant harbors more than 30 mutations in the spike protein, leading to immune evasion from many therapeutic neutralizing antibodies. We reveal that a receptor-binding domain (RBD)-targeting monoclonal antibody, 35B5, exhibits potent neutralizing efficacy to Omicron. Cryo-electron microscopy structures of the extracellular domain trimer of Omicron spike with 35B5 Fab reveal that Omicron spike exhibits tight trimeric packing and high thermostability, as well as significant antigenic shifts and structural changes, within the RBD, N-terminal domain (NTD), and subdomains 1 and 2. However, these changes do not affect targeting of the invariant 35B5 epitope. 35B5 potently neutralizes SARS-CoV-2 Omicron and other variants by causing significant conformational changes within a conserved N-glycan switch that controls the transition of RBD from the “down” state to the “up” state, which allows recognition of the host entry receptor ACE2. This mode of action and potent neutralizing capacity of 35B5 indicate its potential therapeutic application for SARS-CoV-2.

Case Report: Adolescent-Onset Isolated Nephronophthisis Caused by a Novel Homozygous Inversin Mutation

Objective: Nephronophthisis (NPHP) is a rare autosomal recessive inherited kidney disease that can cause cystic enlargement of the kidneys, and lead to end-stage renal disease (ESRD) before the age of 30 years. Herein we describe a case of adolescent-onset NPHP with a novel homozygous mutation in the inversin gene (INVS).

Methods: The patient was a 15-year-old Chinese boy who presented with ESRD. Genetic testing was performed via whole exome sequencing and validated via Sanger sequencing. A novel homozygous INVS mutation was identified (c. 1909C > T; p. Gln637Ter).

Results: The results of laboratory examinations included urinary protein 1.05 g/24 h, urine erythrocyte count 5/high-power field, serum creatinine 1,026.2 μmol/L, and estimated glomerular filtration rate 5.8 ml/min/1.73 mm². Extrarenal features included hypertension and moderate anemia, and his parents were consanguineous (first cousins). A homozygous 1-bp substitution resulting in a nonsense mutation (c. 1909C > T; p. Gln637Ter) in exon 15 of INVS was detected via whole exome sequencing, and validated via Sanger sequencing. According to the classification system of the American College of Medical Genetics and Genomics, the mutated gene in INVS is strongly pathogenic (PVS1+PM2+PP3+PP5). His parents and a younger brother were heterozygous carriers. Based on the above results he was diagnosed with juvenile type 2 NPHP. He underwent hemodialysis, and received a kidney transplant after 2 months. He is currently recovering well, with a serum creatinine level of 117 μmol/L and an estimated glomerular filtration rate of 79.6 ml/min/1.73 mm².

Conclusion: Here we have described an extremely rare case of adolescent-onset type 2 NPHP caused by a homozygous INVS mutation. The patient had progressed to ESRD by the age of 15 years. The current report will deepen our understanding of the clinical and genetic basis of this disease.

POS0014 EFFICACY AND SAFETY OF JAK INHIBITORS IN REFRACTORY OR INITIAL TREATMENT OF ADULT ONSET STILL’S DISEASE

Background

Inappropriate activation of pro-inflammatory cytokines such as interleukin (IL)-1, IL-6 or IL-18, is a pathogenic cornerstone in adult onset Still’s disease (AOSD). Beyond therapies targeting IL-1 and IL-6, Janus kinases (JAK) inhibitors have been suggested to be efficient in refractory AOSD patients [1].

Objectives

To assess the efficacy and safety of JAK inhibitors in the treatment of AOSD patient refractory to, or with initial treatment.

Methods

This retrospective study was based on our single center of the department of rheumatology and immunology. The data was collected from the patients’ medical records using a standardized questionnaire and analyzed at different time points. The response to JAK inhibitors was categorized as complete remission (CR), partial remission (PR) or failure (F) [2].

Results

7 patients were recruited (Table 1), including 4 refractory patients and 3 initial patients. Mean age at JAK inhibitor treatment start was 27.5 years for refractory patients and 35 years for initial patients; and mean disease duration was 66.5 months and 1 month respectively. All patients had fever and polyarthritis, 5 patents had rash. In addition, pulmonary hypertension, abnormal liver function tests, abdominal pain, and heart failure were also observed in our patients. Response to corticosteroids, conventional synthetic or biological Disease Modifying Anti-Rheumatic Drugs (DMARDs) had been considered inadequate in 4 refractory patients. Tofacitinib was added in the initial treatment for 3 patients for high disease activity. In total, baricitinib was used in 2 patients and tofacitinib in 5 patients. Steroids were concurrently used in 6 patients, MTX in three, SASP and NSAIDs in one. At a mean follow up of 3.8 months, complete remission was observed in one patient (with tofacitinib), partial remission was in 5 patients (4 patients with tofacitinib and one with baricitinib), and failure in one (patients with baricitinib). At the last visit, steroids could be decreased but not stopped in those 6 patients. Tolerance of JAK inhibitors was excellent, none infectious disease or other severe side effect were observed.

Table 1.

Characteristics of the AOSD patients

No.SexAge (year)Disease Duration (Month)Main symptomsTreatments before JAKionsetJAKiSteroids at onsetConconmitant treatmentSteroids at the end of F-UF-U(month)Outcome1M2629Fever, polyarthritisPred+MTXTofacitinib0MTX04PR2M259Fever, polyarthritis, rash, pulmonary hypertensionPred+MTXBaricitinib16MTX+Pred124F3M3812Fever, polyarthritis, rashPred+MTX+CsA+NSAIDsTofacitinib24Pred123PR4M21216Fever, polyarthritisPred+MTX+SASP+NSAIDs+TNFiBaricitinib4Pred+MTX+SASP+NSAIDs43PR5F331Fever, polyarthritis, rash, abnormal liver function testsPredTofacitinib40Pred25CR6F471Fever, polyarthritis, rash, abdominal painPredTofacitinib36Pred45PR7F251Fever, polyarthritis, rash, heart failurePredTofacitinib40Pred123PR

Pred: prednisone; MTX: Methotrexate; SASP: salicylazosulfapyridine; CsA: ciclosporin A; NSAIDs: Non-Steroidal Antiinflammatory Drugs; TNFi: Tumor necrosis factor inhibitor. CR: complete remission; PR: partial remission; F: failure.

Conclusion

JAK inhibitors treatment may be helpful for some patients with refractory AOSD, or patients with severe disease activity at initial treatment. Different treatment responses were observed in these short series of cases, which might be due to the phenotype of patients. However, the scale of patients in our study was too low to draw a conclusion. Further study and additional information are needed to evaluate more precisely the risk-benefit ratio of this treatment, and a possible difference in efficacy among the different groups of patients or JAK inhibitors.

References

[1]Aosd T, Table E. Ann Rheum Dis 2020;79:842–4.

[2]Vercruysse F, Barnetche T, Lazaro E, et al. Arthritis Res Ther 2019;21:1–11. doi:10.1186/s13075-019-1838-6.

Figure 1.

Changes in laboratory test (A) WBC; (B) CRP; (C) ESR;(D) Ferritin. M0: baseline; M1: month 1; M3: month 3; M5: month 5.

Acknowledgements

None

Disclosure of Interests

None declared

AB1520 EFFECTIVE TREATMENT OF TOCILIZUMAB IN PATIENTS WITH REFRACTORY ADULT-ONSET STILL’S DISEASE

Background

Pro-inflammatory cytokines such as interleukin 6 (IL-6) are involved in the pathogenesis of adult-onset Still’s disease (AOSD). Anti-IL-6 agents such as tocilizumab have been tried to treat AOSD successfully.

Objectives

To access the efficacy of tocilizumab in the treatment of AOSD patient refractory to,or with initial treatment.

Methods

We reviewed three cases with refractory AOSD treated with tocilizumab. All patients fulfill the Cush criteria for AOSD. All patients performed blood culture, auto-antibodies test and bone marrow test to exclude infectious diseases, other rheumatic diseases and tumors. All patients received broad-spectrum antibiotics and had no response. All patients received glucocorticoid therapy and at least one kind of anti-cytokine therapies but didn’t have full response. Then the three patients received intravenous tocilizumab treatment of 8mg/kg every 2 weeks or 4 weeks.

Results

The first patient, a 21-year-old woman, performed positron emission tomography (PET-CT) and lymphoglandula pathology in addition to routine tests. She received high dose methylprednisolone (500mg per day for 3 days and followed by 80mg per day), gamma globulin injection (20g per day for 3 days) and baricitinib 4mg per day for 12 days, but had no response to the treatment. Then she received tocilizumab of 8mg/kg every 2 weeks and stopped baricitinib. And the symptoms and blood tests improved gradually, and the methylprednisolone dose reduced to 16mg per day at the last follow-up.

The second patient is a 52-year-old man, and performed bone marrow cytology and PET-CT to excluded hematological diseases. He received methylprednisolone 80mg per day, adalimumab and tofacitinib treatment. But the patients still got recurrent fever, high ESR, CRP and serum ferritin. Then he stopped adalimumab and tofacitinib, and received tocilizumab of 8mg/kg every 2 weeks and reduced to 8mg/kg every 4 weeks because of economic factors. The patient did not develop fever and the inflammatory indexes such as ESR/CRP gradually decreased to normal range. And methylprednisolone dose reduced to 32mg nowadays.

The third patient is a 30-year-old woman and has recurrent AOSD for 15 years. She had tried glucocorticoids, methotrexate, iguratimod, baritinib and entanercept successively. Yet she still had recurrent arthritis on hand and knee, and elevated ESR/CRP/serum ferritin. Additionally she suffered femoral head necrosis because of excessive doses of glucocorticoid. The patient received tocilizumab 8mg/kg every 4 weeks, then joint symptoms and inflammatory indicators improved significantly. The methylprednisolone dose was also successfully reduced to 4mg/d.

The Figure 1 showed the main course of disease evolution.

Figure 1.

Conclusion

Tocilizumab may be an effective candidate in refractory AOSD despite no response to other treatments.

Disclosure of Interests

None declared

MicroRNA-4463 facilitates the development of colon cancer by suppression of the expression of PPP1R12B

PURPOSE

In the present work, we investigated the expression pattern of miR-4463 in the non-metastasis and metastasis colorectal cancer (CRC) patients and its regulation axis.

METHODS

RT-qPCR assay was performed to assess miR-4463 expression in the serum and tissues of patients with non-metastasis and metastasis, and in the CRC cell lines. MTT assay, colony formation assay, transwell assay, and flow cytometry assay were used to examine the role of miR-4463 in CRC cell viability, proliferation, and migration. Bioinformatic analysis was used to identify the potential target gene of miR-4463, and the targeting relationship between miR-4463 and PPP1R12B was verified in vitro using dual luciferase assay. Western blotting assay was used to determine the protein level of the target gene PPP1R12B in CRC cells under the transfections of miR-4463 mimic, inhibitor and vectors overexpressing PPP1R12B.

RESULTS

miR-4463 was markedly increased in the non-metastasis CRC tissues, and increased even higher in the metastasis CRC tissues, while miR-4463 expression had no significant difference in serum from non-metastasis and metastasis CRC samples. Besides, miR-4463 was upregulated in CRC cell lines. Functionally, miR-4463 promoted CRC cell proliferation, migration, and inhibiting cell apoptosis. Further analysis revealed that the miR-4463/PPP1R12B axis was responsible for the role of this miRNA.

CONCLUSION

We reported the roles of miR-4463 in CRC proliferation and migration, supporting that miR-4463 could be a potential predictive diagnostic marker for colon cancer.

Comparison of two fascial defect closure methods for laparoscopic incisional hernia repair

PURPOSE

Currently there is no consensus regarding the optimal surgical approach to an incisional hernia measuring less than 10 cm. Certain hernia features including defect size, intra-abdominal adhesions, and overlying scar/skin properties contribute to choosing an open versus a laparoscopic approach. This retrospective cohort study was designed to compare incisional hernia defects repaired with laparoscopic suture closure to a hybrid approach with open defect closure, both with laparoscopic intraperitoneal onlay mesh (IPOM) reinforcement.

METHODS

We identified 164 consecutive patients who underwent incisional hernia repair from two centers, North York General Hospital (NYGH) and Humber River Hospital (HRH) between 2015 and 2020. Patients were grouped by totally laparoscopic or hybrid fascial closure. Both techniques included laparoscopically placed intra-peritoneal mesh with 5 cm of overlap in all directions. Patients were analyzed by age, sex, body mass index (BMI), ASA class and hernia size. Primary outcomes included surgical site infection (SSI), other wound complications including seroma/hematoma, length of hospital stay, pain reported at follow-up appointment, and hernia recurrence.

RESULTS

Post-operative pain, surgical site infections and seromas did not differ between the totally laparoscopic and hybrid approach. The recurrence rates were 5.8% and 6.8% for the laparoscopic and hybrid group, respectively, which were not significantly different. The time to recurrence was 15 months (range 8-12) in the laparoscopic group and 7 months (range 6-36) in the hybrid group, also not significantly different. The hernia defect size and BMI were significantly higher in the hybrid group, without increased wound complications.

CONCLUSION

These results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6 cm.

POS1361 THE CANADIAN RESEARCH GROUP OF RHEUMATOLOGY IN IMMUNO-ONCOLOGY (CanRIO): A NATIONWIDE MULTI-CENTER PROSPECTIVE COHORT

Background

Immune Checkpoint Inhibitors (ICI) have altered the landscape of cancer therapy. However, toxicities are common and up to 80% of patients will develop immune-related adverse events (irAE), including rheumatic irAEs (Rh-irAE), which can often limit their cancer treatment. Our knowledge of clinical manifestations and optimal management of patients with Rh-irAE continues to evolve as these agents are being used to treat a wider variety of cancers. Currently available data is limited to retrospective case series and case reports. There is also scarce data on the use of ICI in patients with pre-existing autoimmune disease (PAD) as these patients are often excluded from clinical trials.

Objectives

To describe the clinical presentation, management and early outcomes of patients exposed to ICI with Rh-irAE or PAD recruited and followed prospectively from multiple sites across Canada.

Methods

Adult patients with Rh-irAE from cancer immunotherapy (CTLA-4, PD-1 or PDL-1 inhibitors) or those with PAD exposed to cancer immunotherapy are prospectively recruited across 9 academic sites in Canada. Standardized clinical and biologic data are also collected. We describe clinical characteristics and management of patients recruited between January 2020 and October 2021, stratified based on the presence or absence of PAD.

Results

103 patients were recruited from 9 sites. From those, 85 had Rh-irAE, 47 had pre-existing musculoskeletal and rheumatic diseases, and 20 had other PAD. The most frequent Rh-irAE were joint manifestations (n = 73). Other Rh-irAE included muscle symptoms (n = 7), connective tissue disease (n = 6), vasculitis (n=2) and sarcoid (n = 3). Prednisone was the most common treatment (n = 53). Intraarticular corticosteroids were used in 7 patients. Eleven patients required conventional synthetic disease-modifying anti-rheumatic drugs (DMARD) and only one required biologic DMARD to control the Rh-irAE. Anti-PD-1 therapies were the most used ICI (56.3%), followed by combination therapy (35.9%). Response to index immunotherapy at 6 months was available for 21 patients. Most patients had partial response (57.1%) and only 4 patients had tumor progression (19.1%). The ICI was permanently discontinued due to an irAE in 21 patients (38.1% with PAD and 61.9% without PAD). There were no deaths related to Rh-irAE.

Conclusion

The initial sample of the CanRIO prospective national cohort suggests that demographic characteristics and tumor representation in people with PAD and without PAD is similar. Patients with PAD are less likely to receive combination therapy (n= 12 vs. n=25) and are less likely to have tumor progression on ICI (n=1) compared to those without PAD (n=3). Selection bias is noted in this initial sample since half of recruited patients have PAD. The CanRIO cohort provides valuable insight into real-world spectrum and management of Rh-irAE secondary to immunotherapy for cancer.

Disclosure of Interests

Shahin Jamal Grant/research support from: CanRIO has received financial support from BMS and Organon, Lourdes Gonzalez Arreola: None declared, Julia Tan: None declared, Carrie Ye: None declared, Janet Roberts: None declared, Aurore Fifi-Mah: None declared, Marie Hudson: None declared, Sabrina Hoa: None declared, Janet Pope: None declared, Ines Colmegna: None declared, C. Thomas Appleton: None declared

OP0248 SEVERE COVID-19 OUTCOMES AMONG PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES: A POPULATION-BASED STUDY

Background

Individuals with autoimmune rheumatic diseases (ARDs) may be at greater risk of severe COVID-19 outcomes than individuals in the general population.

Objectives

This study assesses the risk of COVID-19-related hospitalization, intensive care unit (ICU) admission, and COVID-19-specific mortality in patients with ARDs compared to matched general population comparators.

Methods

We conducted a population-based cohort study, using administrative datasets from British Columbia, Canada (February 2020-August 2021). Among all test-positive SARS-CoV-2 adults, we used ICD codes to identify all individuals with an ARD: rheumatoid arthritis (RA), psoriasis/psoriatic arthritis (PsO/PsA), ankylosing spondylitis (AS), and systemic autoimmune rheumatic diseases (SARDs), including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis, myositis, and adult systemic vasculitides. Individuals with an ARD were matched 1:5 to general population test-positive SARS-CoV-2 individuals on age (± 5 years), sex, month/year of initial positive SARS-CoV-2 test, and health authority. Conditional logistic regression models adjusting for socioeconomic status, Charlson comorbidity index, hypertension, rural address, and number of previous COVID-19 PCR tests were performed to assess risk of COVID-19-related hospitalizations, ICU admissions, and COVID-19-specific mortality (mortality with primary ICD code for COVID-19).

Results

The risk of COVID-19-related hospitalization was significantly increased for patients with ARDs overall (aOR: 1.30) (Table 1). Within ARDs, the patient group at greatest risk of hospitalization was adult systemic vasculitides (aOR: 2.18). The risk of ICU admission was significantly increased for patients with ARDs overall (aOR: 1.30). Within ARDs, the patient group at greatest risk of ICU admission was those with AS (aOR: 2.03). The risk of COVID-19-specific mortality was significantly increased for patients with ARDs overall (aOR: 1.24). Within ARDs, the patient group at greatest risk of COVID-19-specific mortality was those with AS (aOR: 2.15).

Table 1.

Risk of severe COVID-19 outcomes among patients with ARDs

HospitalizationsICU admissionsCOVID-19-specific mortalityn (%)aOR (95% CI)n (%)aOR (95% CI)n (%)aOR (95% CI)ARDs (6,279)780 (12.4)1.30 (1.19, 1.43)225 (3.6)1.30 (1.11, 1.51)229 (3.7)1.24 (1.05, 1.47)ARD comparators (31,130)2,843 (9.1)1.00807 (2.6)1.00847 (2.7)1.00RA(2,067)321 (15.5)1.34 (1.15, 1.54)95 (4.6)1.30 (1.03, 1.65)103 (5.0)1.18 (0.92, 1.52)RA comparators (10,197)1,151 (11.3)1.00336 (3.3)1.00400 (3.9)1.00PsO/PsA(2,695)263 (9.8)1.17 (1.01, 1.37)65 (2.4)0.90 (0.68, 1.19)68 (2.5)0.93 (0.68, 1.26)PsO/PsA comparators (13,411)1,052 (7.8)1.00332 (2.5)1.00309 (2.3)1.00AS(529)51 (9.6)1.36 (0.95, 1.94)20 (3.8)2.03 (1.18, 3.50)13 (2.5)2.15 (1.02, 4.55)AS comparators (2,631)180 (6.8)1.0048 (1.8)1.0032 (1.2)1.00SARDs(1,118)168 (15.0)1.62 (1.32, 2.00)52 (4.7)1.74 (1.24, 2.44)49 (4.4)1.44 (1.00, 2.10)SARDs comparators (5,532)490 (8.9)1.00135 (2.4)1.00157 (2.8)1.00SLE(239)37 (15.5)1.88 (1.18, 3.00)11 (4.6)1.67 (0.75, 3.74)<50.85 (0.17, 4.29)SLE comparators (1,187)77 (6.5)1.0026 (2.2)1.0013 (1.1)1.00Sjogren’s(96)15 (15.6)2.07 (0.94, 4.58)<5*<5*Sjogren’s comparators (477)35 (7.4)1.0014 (2.9)1.0015 (3.2)1.00Myositis(30)5 (16.7)3.18 (0.69, 14.55)<5*<5*Myositis comparators (150)12 (8.0)1.00<51.007 (4.7)1.00Vasculitides(82)25 (30.5)2.18 (1.17, 4.05)8 (9.8)1.70 (0.70, 4.16)<5*Vasculitides comparators (404)64 (15.8)1.0021 (5.2)1.0016 (4.0)1.00

Results for systemic sclerosis not presented; sample size too small.

*Unable to be calculated (small sample size)

Conclusion

The risk of severe COVID-19 outcomes is increased in some ARDs, although magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis, and early intervention with available therapies (e.g., oral antivirals) should be prioritized in these groups according to risk.

Acknowledgements

This work was supported by the Michael Smith Foundation for Health Research (grant COV-2020-1075) and the BC SUPPORT Unit (grant C19-PE-V3).

Disclosure of Interests

None declared

[Current research progress on health problems and health management of E-sports players]

Electronic sports (E-sports) are series of competitive activities different from the traditional physical sports, and E-sports athlete is becoming a new profession. Along with the fast development of E-sports industry, the number of E-sports athletes increased tremendously. The early retirement of some top-ranking athletes caused by occupational injuries has aroused the societal attentions on the health problems of E-sports athletes. Facing special occupational exposure, E-sports athletes encounter different health issues comparing to the counterparts of their ages. It is necessary to scientifically identify their health hazards and common health issues, in order to conduct effective health management for this particular professional group. This review summarized global literature on health issues and health management on E-sports athletes. The research on their health issues were mainly descriptive and there was a paucity on interventional research and health management. These provide references and directions on the future health services and research on E-sports athletes.

A Proinflammatory Diet May Increase Mortality Risk in Patients with Diabetes Mellitus

This was an observational study based on the National Health and Nutrition Examination Survey (NHANES) and National Death Index (NDI) 2009–2014 which aimed to validate whether a proinflammatory diet may increase mortality risk in patients with diabetes mellitus. Dietary inflammatory potential was assessed by dietary inflammatory index (DII) based on 24 h dietary recall. Mortality follow-up information was accessed from NDI, which was then merged with NHANES data following the National Center for Health Statistics (NCHS) protocols. For 15,291 participants from the general population, the average DII was 0.37 ± 1.76 and the prevalence rate of diabetes was 13.26%. DII was positively associated with fasting glucose (β = 0.83, 95% CI: 0.30, 1.36, p = 0.0022), glycohemoglobin (β = 0.02, 95% CI: 0.01, 0.03, p = 0.0009), and the risk of diabetes (OR = 1.05, 95% CI: 1.01, 1.09, p = 0.0139). For 1904 participants with diabetes and a median follow-up of 45 person-months, a total of 178 participants with diabetes died from all causes (mortality rate = 9.34%). People with diabetes who adhered to a proinflammatory diet showed a higher risk of all-cause mortality (HR = 1.71, 95%CI: 1.13, 2.58, p = 0.0108). In summary, DII was positively associated with diabetes prevalence and a proinflammatory diet may increase mortality risk in patients with diabetes mellitus.

Effects of honeycomb extract on the growth performance, carcass traits, immunity, antioxidant function and intestinal microorganisms of yellow bantam broilers

Although many studies have already described the physiological effects of bee products, such as honey, propolis, pollen, and royal jelly, on livestock farming, the health benefits of the honeycomb are still not fully understood. The problem of drug residues and bacterial resistance caused by the abuse of antibiotics is becoming increasingly serious. For this reason, a safe, green substitute has to be sought. We conducted a comparative study of honeycomb extract (HE) and an antibiotic on growth performance, carcass traits, immunity, antioxidant function and intestinal microorganisms of yellow bantam broilers. A total of four hundred eighty 21-day-old female yellow bantam broilers were randomly divided into 5 groups of 6 replicates of 16 birds each. The 5 groups were as follows, with birds receiving a basal diet supplemented with 150 ppm (mg/kg) of chlortetracycline (CTE), a basal diet without HE (control group), and a basal diet with 0.1%, 0.15%, or 0.2% HE for 60 days. The results showed that HE addition significantly increased average daily feed intake (ADFI), average daily gain (ADG), decrease feed gain ratio (F/G) from 21 to 80 and 51 to 80 days of age compared to the control group, with all 3 HE addition groups having statistically identical values to the antibiotic group. HE implementation dramatically increased spleen index, serum immunoglobulin A (IgA), immunoglobulin M (IgM,), glutathione peroxide (GSH-Px), superoxide dismutase (SOD), total antioxidant capacity (T-AOC), and total cecum bacteria and Lactobacillus compared to the control group, numerically at the same level as, or even better than, the antibiotic group. HE and CTE both markly reduced serum malondialdehyde (MDA) concentration compared to the control group, with higher concentrations of HE reducing the effect more dramatically than antibiotics. Both HE and CTE significantly raised dressed yield compared to the control group. In summary, HE, as a potential antibiotic alternative, improved growth performance, carcass traits, immune function, serum antioxidant capacity and intestinal microorganisms in yellow bantam broilers. According to the cubic regression analyses, the recommended supplemental dose of HE was calculated to be 0.15 to 0.17% for female yellow bantam broilers between 21 and 80 d of age.

A196 DIARRHEA AS A PRESENTING SYMPTOM OF RELAPSED GRANULOMATOSIS WITH POLYANGIITIS

Background

Granulomatosis with polyangiitis (GPA) is a rare, small-to-medium sized-vessel vasculitis that typically involves the sinus, respiratory, and renal systems. The gastrointestinal (GI) tract is rarely involved, but its exact frequency is poorly characterized. GI symptoms have been reported to occur in up to 10% of acute presentations, and a historic series of 56 autopsies of GPA patients found 24% to have focal necrotizing arteriolitis of the intestine (Storesund, 1998). There are few case reports of colitis associated with GPA. They commonly describe abdominal pain, rectal bleeding, and less frequently, perforation, early in the disease course in conjunction with other classic systems involvement which aid in the diagnosis of GPA.

Aims

We present the case of a 77 year-old woman with lung biopsy-proven cANCA-positive GPA who was found to have colonic vasculitis after she had been in remission for several years.

Methods

Case report and literature review

Results

The patient presented with a 1-month history of progressive back pain, followed by 1 week of severe abdominal pain and watery diarrhea. She was afebrile, with a leukocyte count of 13.8x109/L, C-reactive protein of 213 mg/L, and fecal calprotectin of 669mg/kg. cANCA was strongly positive at 5.4 AI. Computed tomography scan revealed focal inflammatory change at the cecum and terminal ileum. Stool cultures were negative. Colonoscopy showed a polypoid, inflammatory-appearing hard mass at the ileocecal valve with surrounding fragile mucosa. Ileocecal valve biopsies described fibropurulent material and granulation tissue consistent with ulcer bed with surrounding mucosa showing chronic ischemic colitis with various degrees of acute cryptitis. The most likely etiology was speculated by the pathologist to be involvement of the colon by vasculitis, as other etiologies appeared to be ruled out. The patient had mild kidney injury, but no additional lung findings, in contrast to her initial presentation of GPA. She was started on prednisone 50mg/day. Her back pain, abdominal pain, and diarrhea resolved within 1 week, and renal function improved. Currently, there is a plan to start Rituximab for chronic treatment.

Conclusions

Our case of GPA-associated colitis is unique for several reasons. First, most case reports describe rectal bleeding as the presenting symptom of GPA colitis, whereas our patient presented with non-hemorrhagic diarrhea. Second, where available, reports of colitis correlated endoscopically with colonic ulcerations, whereas our patient had an ileocecal mass. Third, most reports present colitis associated with a new diagnosis of GPA, whereas our patient presented with colitis as new GI system involvement with likely inflammatory back pain as the presenting feature of GPA relapse. While a rare feature, colitis secondary to GPA can be considered in the appropriate context.

Funding Agencies

None

Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension

The association of heart rate (HR) dipping pattern with renal outcomes in chronic kidney disease (CKD) patients with hypertension has never been investigated. In order to demonstrate if HR dipping pattern is a risk factor for renal outcomes, cardiovascular (CV) diseases, and mortality in hypertensive patients with CKD, we conducted the prospective longitudinal observational study. Patients were divided into three groups according to their nocturnal HR: HR dippers (night-day HR ratio ≤ 0.9), HR non-dippers (0.9 < night-day HR ratio ≤ 1.0), and HR risers (night-day HR ratio > 1.0). The primary outcome was renal endpoint, a composite outcome of progression to end-stage renal disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥ 50%; the secondary outcomes included poor renal outcomes, CV events, and death. A total of 34 (11.3%) patients reached renal endpoint after a follow-up of 34 ± 17 months. Both HR non-dippers and HR risers were predictive to renal endpoint (hazard ratio 2.58, 95% confidence interval (CI) 1.04- 6.4, P = .04; hazard ratio 3.95, 95% CI 1.33- 11.79, P = .01, respectively), while only HR risers was shown to be correlated with a decline in eGFR≥ 50% (hazard ratio 5.28, 95% CI 1.45-19.16, P < .05), and decline in eGFR (β -0.17, 95% CI -0.33- -0.01, P = .04). No predictive value was found for HR dipping pattern to mortality and CV events. In conclusion, our study provided the first evidence that HR non-dippers, especially risers were a risk factor for poor renal outcomes in hypertensive patients with CKD.