Chronic Fluoride Exposure Induces Ovarian Dysfunction and Potential Association with Premature Ovarian Failure in Female Rats

Chronic fluorosis has been widely investigated for its adverse effects on skeletal and neurological health; however, its impact on reproductive health, especially in females, remains underexplored. In this study, female Sprague-Dawley rats were exposed to different fluoride concentrations (0.75, 50, and 100 mg/L) in their drinking water for six months. Dental fluorosis and increased urinary fluoride content were observed in fluoride-exposed rats, reflecting fluoride accumulation and exposure levels. Chronic fluorosis resulted in reduced ovary organ coefficient, indicating harmful effects on ovarian tissue. Additionally, the number of ovarian primordial and primary/secondary follicles decreased, while the number of atresia follicles increased. Furthermore, chronic fluorosis led to disrupted estrous cycles. Hormonal analysis revealed altered secretion of estrogen, progesterone, anti-Müllerian hormone, luteinizing hormone, follicular stimulating hormone, and inhibin B in response to fluoride exposure. Ultrastructural observation of ovarian granulosa cells showed evidence of apoptosis, which was further confirmed by flow cytometry. Caspase-3 activity was increased, and ATP levels were decreased, suggesting mitochondrial impairment and apoptosis induction. The mRNA and protein expression of BMP15 and GDF9, essential regulators of ovarian function, significantly decreased with increasing fluoride concentration. Furthermore, gene expression analysis identified a panel of premature ovarian failure-related genes that were downregulated in fluoride-exposed rat ovaries. These findings suggest that chronic fluoride exposure may contribute to ovarian dysfunction and possibly the pathogenesis of premature ovarian failure. Understanding the toxicological effects of chronic fluoride exposure on ovarian function is essential for identifying potential environmental risk factors affecting female reproductive health.

Kurarinone, a flavonoid from Radix Sophorae Flavescentis, inhibits RANKL-induced osteoclastogenesis in mouse bone marrow-derived monocyte/macrophages

Inflammation-induced osteoclast proliferation is a crucial contributor to impaired bone metabolism. Kurarinone (KR), a flavonoid extracted from the Radix Sophorae Flavescentis, exhibits notable anti-inflammatory properties. Nevertheless, the precise influence of KR on osteoclast formation remains unclear. This study's objective was to assess the impact of KR on osteoclast activity in vitro and unravel its underlying mechanism. Initially, a target network for KR-osteoclastogenesis-osteoporosis was constructed using network pharmacology. Subsequently, the intersecting targets were identified through the Venny platform and a PPI network was created using Cytoscape 3.9.1. Key targets within the network were identified employing topological algorithms. GO enrichment and KEGG pathway analysis were then performed on these targets to explore their specific functions and pathways. Additionally, molecular docking of potential core targets of KR was conducted, and the results were validated through cell experiments. A total of 83 target genes overlapped between KR and osteoclastogenesis-osteoporosis targets. Enrichment analysis revealed their role in inflammatory response, protein tyrosine kinase activity, osteoclast differentiation, and MAPK and NF-κB signaling pathways. PPI analysis and molecular docking demonstrate that key targets MAPK14 and MAPK8 exhibit more stable binding with KR compared to other proteins. In vitro experiments demonstrate that KR effectively inhibits osteoclast differentiation and bone resorption without cellular toxicity. It suppresses key osteoclast genes (NFATc1, c-Fos, TRAP, MMP9, Ctsk, Atp6v2), hinders IκB-α degradation, and inhibits ERK and JNK phosphorylation, while not affecting p38 phosphorylation. The results indicate that KR may inhibit osteoclast maturation and bone resorption by blocking NF-κB and MAPK signaling pathways, suggesting its potential as a natural therapeutic agent for osteoporosis.

Impact of obesity-related indicators on first-pass effect in patients with ischemic stroke receiving mechanical thrombectomy

PURPOSE

The first-pass effect (FPE), defined as complete revascularization after a single thrombectomy pass in large vessel occlusion, is a predictor of good prognosis in patients with acute ischemic stroke (AIS) receiving mechanical thrombectomy (MT). We aimed to evaluate obesity-related indicators if possible be predictors of FPE.

METHODS

We consecutively enrolled patients with AIS who were treated with MT between January 2019 and December 2021 at our institution. Baseline characteristics, procedure-related data, and laboratory test results were retrospectively analyzed. A multivariable logistic regression analysis was performed to evaluate the independent predictors of FPE.

RESULTS

A total of 151 patients were included in this study, of whom 47 (31.1%) had FPE. After adjusting for confounding factors, the independent predictors of achieving FPE were low levels of body mass index (BMI) (OR 0.85, 95% CI 0.748 to 0.971), non-intracranial atherosclerotic stenosis (OR 4.038, 95% CI 1.46 to 11.14), and non-internal carotid artery occlusion (OR 13.14, 95% CI 2.394 to 72.11). Patients with lower total cholesterol (TC) (< 3.11 mmol/L) were more likely to develop FPE than those with higher TC (≥ 4.63 mmol/L) (OR 4.280; 95% CI 1.24 to 14.74) CONCLUSION: Lower BMI, non-intracranial atherosclerotic stenosis, non-internal carotid artery occlusion, and lower TC levels were independently associated with increased rates of FPE in patients with AIS who received MT therapy. FPE was correlated with better clinical outcomes after MT.

Experimental and Simulation Investigation on Fatigue Performance of H13 Steel Tools in Friction Stir Welding of Aluminum Alloys

As the central component in friction stir welding, the design and manufacture of welding tools for aluminum alloys have garnered substantial attention. However, the understanding of tool reliability during the welding process, especially in terms of fatigue performance, remains unclear. This paper focuses on the welding of AA2219-T4 as a case study to elucidate the predominant failure mode of the tool during the friction stir welding (FSW) of aluminum alloys. Experimental methods, including FSW welding and fracture morphology analysis of the failed tool, coupled with numerical simulation, confirm that high-cycle mechanical fatigue fracture is the primary mode of the tool failure. Failures predominantly occur at the tool pin's root and the shoulder end face with scroll concave grooves. The experimental and simulation results exhibit a noteworthy agreement, validating the reliability of the simulation model. The FSW Arbitrary Lagrangian-Eulerian (ALE) model developed in this study analyzes stress distribution and variation under the thermo-mechanical coupling effect of the tool. It reveals that stress concentration resulting from structural changes in the tool is the primary driver of fatigue crack initiation. This is attributed to exposure to alternating cyclic stresses such as bending, tension, and torsion at the tool pin's root, manifesting as multiaxial composite mechanical fatigue. Among these stresses, bending alternating cyclic stress exerts the most significant influence. The paper employs the Tool Life module in DEFORM software to predict the fatigue life of the tool. Results indicate that reducing welding speed or increasing rotation speed can enhance the tool's fatigue life to some extent. The methodology proposed in this paper serves as a valuable reference for optimizing FSW structures or processes to enhance the fatigue performance of welding tools.

Fabrication of bimetallic Ag@ZnO nanocomposite and its anti-cancer activity on cervical cancer via impeding PI3K/AKT/mTOR pathway

INTRODUCTION

Bimetallic nanoparticles, specifically Zinc oxide (ZnO) and Silver (Ag), continue to much outperform other nanoparticles investigated for a variety of biological uses in the field of cancer therapy. This study introduces biosynthesis of bimetallic silver/zinc oxide nanocomposites (Ag@ZnO NCs) using the Crocus sativus extract and evaluates their anti-cancer properties against cervical cancer.

METHODS

The process of generating bimetallic nanoparticles (NPs), namely Ag@ZnO NCs, through the utilization of Crocus sativus extract proved to be uncomplicated and eco-friendly. Various methods, such as UV-vis, DLS, FTIR, EDX, and SEM analyses, were utilized to characterize the generated Ag@ZnO NCs. The MTT assay was employed to assess the cytotoxic properties of biosynthesized bimetallic Ag@ZnO NCs against the HeLa cervical cancer cell line. Moreover, the impact of Ag@ZnO NCs on HeLa cells was assessed by examining cell survival, ROS production, MMP levels, and induced apoptosis. Through western blot analysis, the expression levels of the PI3K, AKT, mTOR, Cyclin D, and CDK proteins seemed to be ascertained. Using flow cytometry, the cancer cells' progression through necrosis and apoptosis, in addition to the cell cycle analysis, were investigated.

RESULTS

Bimetallic Ag@ZnO NCs that were biosynthesized showed a high degree of stability, as demonstrated by the physicochemical assessments. The median size of the particles in these NCs was approximately 80-90 nm, and their zeta potential was -14.70 mV. AgNPs and ZnO were found, according to EDX data. Further, Ag@ZnO NCs hold promise as a potential treatment for cervical cancer. After 24 hours of treatment, a dosage of 5 µg/mL or higher resulted in a maximum inhibitory effect of 58 ± 2.9. The concurrent application of Ag/ZnO NPs to HeLa cells resulted in elevated apoptotic signals and a significant generation of reactive oxygen species (ROS). As a result, the bimettalic Ag@ZnO NCs treatment has been recognized as a chemotherapeutic intervention by inhibiting the production of PI3K, AKT, and mTOR-mediated regulation of propagation and cell cycle-regulating proteins.

CONCLUSIONS

The research yielded important insights into the cytotoxic etiology of biosynthesized bimetallic Ag@ZnO NCs against HeLa cells. The biosynthesized bimetallic Ag@ZnO NCs have a significant antitumor potential, which appears to be associated with the development of oxidative stress, which inhibits the development of the cell cycle and the proliferation of cells. Therefore, in the future, biosynthesized bimetallic Ag@ZnO NCs may be used as a powerful anticancer drug to treat cervical cancer.

Neutrophil Nanodecoys Inhibit Tumor Metastasis by Blocking the Interaction between Tumor Cells and Neutrophils

Cancer metastasis is the main cause of cancer-related deaths and involves the interaction between tumor cells and neutrophils. In this study, we developed activated neutrophil membrane-coated nanoparticles (aNEM NPs) as nanodecoys to block neutrophil-mediated cancer metastasis. The aNEM NPs were fabricated by cloaking poly(lactic acid) nanoparticles with membranes derived from activated neutrophils and inherited the functional proteins of activated neutrophils. We demonstrated that aNEM NPs could interfere with the recruitment of neutrophils to the primary tumor and premetastatic niches, inhibit the adhesion of neutrophils to tumor vascular endothelium and circulating tumor cells (CTCs), and disrupt the formation of CTC-neutrophil clusters in vitro and in vivo. In 4T1-bearing mice, aNEM NPs could effectively reduce breast cancer metastasis to various organs in mice. Our results suggest that aNEM NPs are a promising nanomedicine for preventing or treating cancer metastasis by acting as neutrophil nanodecoys.

Effect of two different modalities of hysterectomy on wound infection and wound dehiscence in obese patients

This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.

Network Pharmacology and Experimental Validation to Elucidate the Pharmacological Mechanisms of Luteolin Against Chondrocyte Senescence

BACKGROUND

Luteolin, a flavonoid found in various medicinal plants, has shown promising antioxidant, anti-inflammatory, and anti-aging properties. The cartilaginous endplate (CEP) represents a crucial constituent of the intervertebral disc (IVD), assuming a pivotal responsibility in upholding both the structural and functional stability of the IVD.

OBJECTIVE

Exploring the precise mechanism underlying the protective effects of luteolin against senescence and degeneration of endplate chondrocytes (EPCs).

METHODS

Relevant targets associated with luteolin and aging were obtained from publicly available databases. To ascertain cellular functions and signaling pathways, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were employed. Core genes were identified through the construction of a protein-protein interaction (PPI) network. Molecular docking (MD) was utilized to assess the binding affinity of luteolin to these core genes. Finally, the impact of luteolin on the senescence and degeneration of EPCs was evaluated in an in vitro cellular senescence model induced by tert-butyl hydroperoxide (TBHP).

RESULTS

There are 145 overlapping targets between luteolin and senescence. Analysis using GO revealed that these targets primarily participate in cellular response to oxidative stress and reactive oxygen species. KEGG analysis demonstrated that these markers mainly associate with signaling pathways such as p53 and PI3K-Akt. MD simulations exhibited luteolin's binding affinity to P53, Cyclin-dependent kinase (CDK)2, and CDK4. Cell cycle, cell proliferation, and β- galactosidase assays confirmed that luteolin mitigated senescence in SW1353 cells. Western blot assays exhibited that luteolin significantly suppressed the expression of Matrix Metallopeptidase (MMP) 13, P53, and P21, while concurrently promoting CDK2, CDK4, and Collagen Type II Alpha 1 (COL2A1) expression.

CONCLUSION

In summary, luteolin demonstrated beneficial properties against aging and degeneration in EPCs, offering novel insights to mitigate the progression of intervertebral disc degeneration (IVDD).

[Study on primary screening technique for children with autism spectrum disorder]

To explore screening tools for children with autism spectrum disorder (ASD), which are convenient for primary hospitals, it can provide basic data for formulating ASD prevention policies. This was a cross-sectional study by cluster sampling. Huyi District and Xincheng District were extracted for investigation in Xi'an City. From July 2021 to September 2022, all children aged from 3 months to 36 months who live in the two districts were subjected to primary screening. The child care physician used the routine screening tool "warning signs checklist for screening psychological, behavioral and developmental problems of children" and cartoon pictures of "early high-risk warning signs of autism", the children who were positive in the initial screening were referred to the district level maternal and child health hospital for re-screening, and those who were positive in the re-screening were referred to Xi 'an Children's Hospital for diagnosis. The results showed that a total of 17 905 children aged from 3 months to 36 months were initially screened in the two districts, including 10 588 children aged from 18 months to 36 months, 50 children who were positive in the initial screening and 50 children who were re-screened. 23 children (18 boys and 5 girls) were diagnosed with ASD. The prevalence rate of ASD in children was 2.17‰ (95% confidence interval:1.29‰-3.06‰). 42 children were positive for "warning signs checklist" at the preliminary screening, and 19 were confirmed as ASD. 27 children were positive for "cartoon pictures" in the preliminary screening, and 23 were confirmed with ASD. The "cartoon pictures" in the preliminary screening and diagnosis of consistent rate was higher than the "warning signs checklist", two kinds of screening methods comparison were statistically significant difference in the odds of consistent (χ2=11.01, P=0.001). In conclusion, relying on the three-level network of maternal and child health care, it is conducive to the whole process management of screening and diagnosis of children with ASD, and to guide the formulation of prevention policies. The cartoon pictures of "early high-risk warning signs of autism" can assist the identification of children with ASD based on the "warning signs checklist", which is simple, effective and suitable for promotion in the community health care.

Identification and adaptive evolution analysis of glutaredoxin genes in Populus spp

Glutaredoxin (GRX) is a class of small redox proteins widely involved in cellular redox homeostasis and the regulation of various cellular processes. The role of GRX gene in the differentiation of Populus spp. is rarely reported. We compared the similarities and differences of GRX genes among four sections of poplar using bioinformatics, corrected the annotations of some GRX genes, and focused on analysing their transcript profiling and adaptive evolution in Populus spp. A total of 219 GRX genes were identified in four sections of poplar, among which annotations for 13 genes were corrected. Differences in GRX genes were found between sect. Turanga, represented by P. euphratica, and other poplar sections. Most notably, P. euphratica had the smallest number of duplication events for GRX genes (n = 9) and no tandem duplications, whereas there were >25 duplication events for all other poplars. Furthermore, we detected 18 pairs of GRX genes under positive selection pressure in various sections of poplar, and identified two groups of GRX genes in the Salicaceae that potentially underwent positive selection. Expression profiling results showed that the PtrGRX34 and its orthologous genes were upregulated under stress treatments. In summary, the GRX gene family underwent expansion during poplar differentiation, and some genes underwent rapid evolution during this process, which may be beneficial for Populus spp. to adapt to environmental changes. This study may provide more insights into the molecular mechanisms of Populus spp. adaptation to environmental changes and the adaptive evolution of GRX genes.

Trophic Transfer of Halogenated Organic Pollutants in a Wetland Food Web: Insights from Compound-Specific Nitrogen Isotope of Amino Acids and Food Source Analysis

A trophic position (TP) model (TPmix model) that simultaneously considered trophic discrimination factor and βGlu/Phe variations was developed in this study and was first applied to investigate the trophic transfer of halogenated organic pollutants (HOPs) in wetland food webs. The TPmix model characterized the structure of the wetland food web more accurately and significantly improved the reliability of TMF compared to the TPbulk, TPAAs, and TPsimmr models, which were calculated based on the methods of stable nitrogen isotope analysis of bulk, traditional AAs-N-CSIA, and weighted βGlu/Phe, respectively. Food source analysis revealed three interlocking food webs (kingfisher, crab, and frogs) in this wetland. The highest HOP biomagnification capacities (TMFmix) were found in the kingfisher food web (0.24-82.0), followed by the frog (0.08-34.0) and crab (0.56-11.7) food webs. The parabolic trends of TMFmix across combinations of log KOW in the frog food web were distinct from those of aquatic food webs (kingfisher and crab), which may be related to differences in food web composition and HOP bioaccumulation behaviors between aquatic and terrestrial organisms. This study provides a new tool to accurately study the trophic transfer of contaminants in wetlands and terrestrial food webs with diverse species and complex feeding relationships.

Potential Predictive Value of Intravoxel Incoherent Motion Magnetic Resonance for Xerostomia of Nasopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

Xerostomia, caused by radiation-induced parotid damage, is the most commonly reported complications of radiotherapy (RT) to nasopharyngeal carcinoma (NPC). This study aimed to evaluate the value of IVIM MR in monitoring radiation parotid gland damage and predicting the risk of xerostomia.

MATERIALS/METHODS

A total of 54 patients were enrolled and underwent IVIM MR scans at before RT, after the fifth fraction, halfway through the course of RT, and at the end of radiotherapy. The parameters of IVIM MR include pseudo-diffusion coefficient (D*), perfusion fraction (f), and pure diffusion coefficient (D). The degree of xerostomia in NPC patients was assessed before each MR examination using the acute radiation morbidity scoring criteria proposed by the Radiation Therapy Oncology Group (RTOG). Concurrently, the time when the patient first reported suffering from xerostomia was recorded. The IVIM parameters trend throughout the RT, and the relationships between IVIM parameters and xerostomia, were analyzed.

RESULTS

All of the IVIM parameters increased from pre-RT to post-RT significantly (all p < 0.001). The increase rate of D from pre-RT to halfway through the RT was 32.61%, which was significantly higher than 15.64% from halfway to post-RT (p<0.001), indicating that cell necrosis in the first half of treatment is significantly higher than that in the second half. Both D* and F had significantly increased from pre-RT to halfway through the radiotherapy (p<0.001), with an increase rate of 19.58% and 29.38%, respectively. However, no significant increase was observed from Halfway to post-RT (p>0.05), with an increase rate of 4.10% and 8.30%, respectively. This may be due to radiation-induced vasculitic dilation that is significant in the first half of the radiotherapy but plateaus in the second half. Pre-D (OR = 23.85; 95% CI = 2.39, 237.82; p = .007) and pre-D* (OR = 0.75; 95% CI = 0.63, 0.91; p = 0.003) are independent influencing factors for xerostomia at 3 months after the completion of RT. D and F were significantly higher after the fifth fraction compared with Pre-RT (both p<0.05), respectively increased 31.25% and 25.16%. D* increase by 15% (p = 0.081). IVIM scans can assess parotid gland damage early. And the average time of parotid damage underwent IVIM scan was 5.99 ± 0.84 (day), much earlier than 11.84 ± 2.74 (day) according to RTOG.

CONCLUSION

Our study indicates that IVIM MR can dynamically monitor radiotherapy-induced parotid gland damage, and much earlier and objectively than RTOG.

Impact of lipid profiles on parenchymal hemorrhage and early outcome after mechanical thrombectomy

OBJECTIVE

We aimed to investigate the association of lipid parameters with parenchymal hemorrhage (PH) and early neurological improvement (ENI) after mechanical thrombectomy (MT) in stroke patients.

METHODS

We retrospectively analyzed consecutive patients who underwent MT between January 2019 and February 2022 at a tertiary stroke center. PH was diagnosed and classified as PH-1 and PH-2 according to the European Cooperative Acute Stroke Study definition. ENI was defined as a decrease in the National Institutes of Health Stroke Scale (NIHSS) score by ≥8 or an NIHSS score of ≤1 at 24 h after MT.

RESULTS

Among 155 patients, PH occurred in 41 (26.5%) patients, and 34 (21.9%) patients achieved ENI. In multivariate analysis, lower triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) value (OR = 0.51; 95% CI 0.30-0.89; p = 0.017) and higher HDL-C level (OR = 5.83; 95% CI 1.26-26.99; p = 0.024) were independently associated with PH. The combination of TG <0.77 mmol/L and HDL-C ≥ 0.85 mmol/L was the strongest predictor of PH (OR = 10.73; 95% CI 2.89-39.87; p < 0.001). A low HDL-C level was an independent predictor of ENI (OR 0.13; 95% CI 0.02-0.95; p = 0.045), and PH partially accounts for the failure of ENI in patients with higher HDL-C levels (estimate: -0.05; 95% CI: -0.11 to -0.01; p = 0.016).

INTERPRETATION

The combination of lower TG level and higher HDL-C level can predict PH after MT. Postprocedural PH partially accounts for the failure of ENI in patients with higher HDL-C levels. Further studies into the pathophysiological mechanisms underlying this observation are of interest.

Mental health status and related influencing factors in patients with COVID-19

BACKGROUND

The outbreak of the Corona Virus Disease 2019 (COVID-2019) has resulted in a significant number of diagnosed patients requiring treatment in designated hospitals. However, limited evidence exists regarding the prevalence of mental health problems and associated psychological factors in COVID-19 patients.

OBJECTIVES

This study investigated the prevalence rates of anxiety, depression, and insomnia among COVID-19 patients, as well as explored the associations between these mental health problems and psychological factors.

METHODS

A cross-sectional study was conducted among 387 COVID-19 patients in a designated shelter hospital. Online measures were used to assess anxiety, depression, insomnia, social support, coping styles, and emotional regulation. Data were analyzed to determine the prevalence rates of mental health problems and examine the associations between these problems and the psychological factors.

RESULTS

The results revealed high prevalence rates of anxiety (21.80%), depression (49.0%), and insomnia (63.70%) among COVID-19 patients. Objective social support scores and positive coping style scores were significantly associated with lower levels of anxiety, depression, and insomnia, respectively. Conversely, high negative coping style scores, higher education level, and self-perceived illness severity, were significantly related to higher levels of anxiety, depression, or insomnia symptoms. Emotional regulation scores did not show a significant association with any of the examined mental health problems.

CONCLUSIONS

These findings have implications for guiding psychological interventions tailored to COVID-19 patients in future outbreaks. By targeting social support and promoting adaptive coping strategies, psychological interventions can address the psychological distress experienced by COVID-19 patients.

Preparation of a Novel Formaldehyde-Free Impregnated Decorative Paper Containing MnO2 Nanoparticles for Highly Efficient Formaldehyde Removal

The loading of catalytic manganese dioxide (MnO₂) nanoparticles onto an impregnated decorative paper has been an effective method for the removal of indoor formaldehyde (HCHO) pollutants. However, its preparation can present numerous challenges, including instability in dipping emulsions and leaching. In this investigation, a novel and stable formaldehyde-free polyacrylate dipping emulsion containing MnO₂ particles was prepared and then back-coated on a decorative paper. To improve the dispersion and fixation, the MnO₂ was modified with silane. HCHO can undergo physical adsorption on the cellulosic fibers present in the paper, while it can also undergo chemical degradation into CO₂ within the MnO₂ groups. The silane not only enhanced the interfacial adhesion to a polyacrylate resin but also increased the interlayer distance, thereby creating a larger space for HCHO absorption. The impregnated decorative paper back-coated with 10 wt % of silane-modified MnO₂ exhibited a removal efficiency of approximately 90% for HCHO at 20 °C. The removal rate further improved to approximately 100% when the temperature was increased to 60 °C. Moreover, it is worth noting that the release of volatile organic compounds was exceptionally minimal. Additionally, the particleboard bonded with this impregnated decorative paper exhibited an extremely low emission of HCHO, with a value that approached 0 mg·L^-1. Furthermore, the bonding strength of the surface remained unaffected. Therefore, this study provides a simple and eco-friendly method for effectively removing HCHO, which can enhance indoor air quality.

Application of amino acids nitrogen stable isotopic analysis in bioaccumulation studies of pollutants: A review

Accurately quantifying trophic positions (TP) to describe food web structure is an important element in studying pollutant bioaccumulation. In recent years, compound-specific nitrogen isotopic analysis of amino acids (AAs-N-CSIA) has been progressively applied as a potentially reliable tool for quantifying TP, facilitating a better understanding of pollutant food web transfer. Therefore, this review provides an overview of the analytical procedures, applications, and limitations of AAs-N-CSIA in pollutant (halogenated organic pollutants (HOPs) and heavy metals) bioaccumulation studies. We first summarize studies on the analytical techniques of AAs-N-CSIA, including derivatization, instrumental analysis, and data processing methods. The N-pivaloyl-i-propyl-amino acid ester method is a more suitable AAs derivatization method for quantifying TP. The AAs-N-CSIA application in pollutant bioaccumulation studies (e.g., Hg, MeHg, and HOPs) is discussed, and its application in conjunction with various techniques (e.g., spatial analysis, food source analysis, and compound tracking techniques, etc.) to research the influence of pollutant levels on organisms is summarized. Finally, the limitations of AAs-N-CSIA in pollutant bioaccumulation studies are discussed, including the use of single empirical values of β_glu/phe and TDF_glu/phe that result in large errors in TP quantification. The weighted β_glu/phe and the multi-TDF_glu/phe models are still challenging to solve for accurate TP quantification of omnivores; however, factors affecting the variation of β_glu/phe and TDF_glu/phe are unclear, especially the effect of pollutant bioaccumulation in organisms on internal AA metabolic processes.

Evaluation of the Efficiency of TIMP-2 as a Biomarker for Acute Kidney Injury in Sepsis

The aim of this study was to evaluate the biomarker potential of TIMP-2 in septic-induced acute kidney injury (AKI). Healthy male rats (n=56, age 8-10 weeks, body weight 250-300 g) were randomized into 3 groups: controls (intact rats, n=6), sham-operated (SO, n=24), and sepsis model (cecum ligation and perforation, CLP, n=24). Thirty minutes before and 6, 12, 24, and 48 h after surgery, blood samples were collected to measure serum creatinine, blood urea nitrogen (BUN), and TIMP-2 and the kidneys were isolated for histopathological analysis and Western blotting. The key sepsis-related genes were screened through bioinformatics analysis. In 24 and 48 h after surgery, 2 rats in the SO group reached the diagnostic criteria of AKI (increased levels of serum creatinine and BUN). In the CLP group, serum creatinine in 6 h after the surgery was slightly higher than 30 min before the surgery, but this change did not meet the diagnostic criteria for AKI. In the CLP group, BUN was normal 6 h after the surgery, but increased after 12 h. In more than 50% rats of the CLP group, serum creatinine and BUN significantly increased 12 h after operation, so this can be diagnosed as AKI. In rats of the CLP group, plasma TIMP-2 was elevated 6 h after surgery and increased with time, suggesting that plasma TIMP-2 can be used as an early marker of AKI. Histological examination of the kidneys in this group revealed destruction of the renal tubular structure, swelling of renal tubular epithelium, the disappearance of brush edge and collapse of necrotic epithelial cells, etc., and the degree of damage increased with time. Immunohistochemistry showed that TIMP-2 was expressed in rats of the CLP group at all terms of the experiment. The expression of TIMP-2 and pyroptosis-related proteins (NLRP3, IL-1β, caspase-1, and GSDMD) in the CLP group was higher than in the SO group (p<0.05) and increased with time, suggesting that pyroptosis is involved in AKI. Thus, plasma TIMP-2 is sensitive indicator for the early detection of kidney injury and can be used as an early biomarker of AKI.

3D multifrequency magnetic resonance elastography in distinguishing endometrial and cervical adenocarcinoma

OBJECTIVES

To prospectively evaluate the value of tomoelastography in determining the underlying origins of uterine adenocarcinoma.

METHODS

This prospective work was approved by our institutional review board, and all patients provided informed consent. 64 patients with histopathologically confirmed adenocarcinomas originated either from the cervix (CAC: cervical adenocarcinoma) or endometrium (EAC: endometrial adenocarcinoma) underwent MRI and tomoelastography examination on a 3.0 T MR scanner. To biomechanically characterize the adenocarcinoma, two MRE-derived parameters maps were provided in the tomoelastography, namely shear wave speed (c, m/s) and loss angle (φ, radian), which represented the stiffness and fluidity, respectively. The MRE-derived parameters were compared by using a two-tailed independent-sample t-test or Mann-Whitney U test. Five morphologic features were also analyzed by using the χ2 test. Logistic regression analysis was used to develop diagnosis models. Delong test was used to compare the receiver operating characteristic curves whith different diagnostic models and evaluate the diagnostic efficiency.

RESULTS

CAC were significantly stiffer and behaved more fluid like than EAC (c: 2.58 ± 0.62 m/s vs.2.17 ± 0.72 m/s, p = 0.029, φ, 0.97 ± 0.19 rad vs.0.73 ± 0.26 rad, p < 0.0001). The diagnostic performance for distinguishing CAC from EAC was similar for c (AUC = 0.71) and for φ (AUC = 0.75). For distinguishing CAC from EAC, the AUC of tumor location was the higher than c and φ (AUC = 0.80). A cmobined model consisting of tumor location, c, and φ achieved the best diagnostic performance, with an AUC of 0.88 (77.27% sensitivity and 85.71% specificity).

CONCLUSIONS

CAC and EAC displayed their unique biomechanical features. 3D multifrequency MRE provided added value to the conventional morphologic features in distinguishing the two types of diseases.

A novel self-wrinkled polyurethane-acrylate wood coating with self-matting, anti-fingerprint performance and skin-tactile feeling via excimer lamp/UV curing

Wrinkled surfaces exist widely in nature and organic living world, such as plants, insects, and skin. The optical, wettability and mechanical properties of materials can be enhanced by artificially preparing regular microstructure on the surface of materials. In this study, a novel self-wrinkled polyurethane-acrylate (PUA) wood coating with self-matting, anti-fingerprint performance and skin-tactile feeling curing by excimer lamp (EX) and ultraviolet (UV) was prepared. The wrinkles were formed on the surface of PUA coating at microscopic level after excimer and UV mercury lamp irradiation. The width and height of the wrinkles on the coating surface can be controlled to adjust the coating performance by changing the curing energy. When the PUA coating samples were cured by excimer lamp and UV mercury lamp with curing energy of 25-40 mJ cm^-2 and 250-350 mJ cm^-2, the excellent coating performances were observed. The gloss value of self-wrinkled PUA coating at 20° and 60° were less than 3 GU, while at 85° was 6.5 GU, which satisfied the demanding of matting coating. Besides, the fingerprints on the coating samples could disappear in 30 s and could still have anti-fingerprint performance after 150 times of anti-fingerprint tests. Furthermore, the pencil hardness, abrasion quantity and adhesion of self-wrinkled PUA coating were 3H, 0.045 g and 0 grade respectively. Finally, the self-wrinkled PUA coating has excellent skin-tactile feeling for touching. The coating can be applied to wood substrates, and has potential application in the field of wood-based panels, furniture and leather.

Zeolite NaP1 synthesized from municipal solid waste incineration fly ash for photocatalytic degradation of methylene blue

The disposal of hazardous municipal solid waste incineration (MSWI) fly ash is a challenge nowadays. Recently, the re-utilization of MSWI fly ash by converting it to useful zeolite-containing materials has attracted attention. However, the zeolitic products fabricated from MSWI fly ash are usually of low quality and rarely reported to be applied for photocatalysis. In this study, valuable zeolites (e.g., NaP1) are synthesized from MSWI fly ash via a modified microwave-assisted hydrothermal method. The key parameters for the hydrothermal method including temperature, duration, the amount of additive, and water volume, are investigated and optimized. Specifically, increasing the hydrothermal temperature can promote the synthesis of zeolitic materials; a relatively long hydrothermal duration is essential to accomplish the assembly of zeolites; the addition of Na₂SiO₃ can increase the precursor for the fabrication of zeolites; the water volume makes little influence on the crystal style of products. Eventually, the hydrothermal condition of 180 °C, 1 h, 0.5 g Na₂SiO₃, and 10 mL water is suggested based on the energy consumption and the quality of zeolites. The product containing zeolite NaP1 from such a condition is further applied to degrade methylene blue by photocatalysis. The removal rate has reached 96% within 12 h, which dramatically surpasses that of the raw fly ash (38%). Such excellent photocatalytic performance is attributed to the 10-fold increased surface area (24.864 m² g^-1) and active metal elements embedding in the zeolite structures.

Synthesis of high-quality NaP1 zeolite from municipal solid waste incineration fly ash by microwave-assisted hydrothermal method and its adsorption capacity

The Si and Al in municipal solid waste incineration fly ash (MSWI FA) can be utilized for zeolite fabrication, which can improve the application value of the products. This study focuses on the fabrication of zeolite from MSWI FA by microwave-assisted hydrothermal (MH) treatment. The effects of magnetic stirring time, Na₂SiO₃ dosage, MH time, and NaOH solution concentration on the crystallization of zeolite NaP1 from MSWI FA are systematically analyzed. The synthetic products are analyzed through spectroscopic and mineralogical methods. The results show that zeolite NaP1 with high crystallinity (51.68 %) can be fabricated by magnetic stirring and MH treatment, and the cation exchange capacity (CEC) of the product can reach a value of 2.58 meq/g, which is approximately 133 times that of the CEC of MSWI FA. The Si/Al ratio plays a decisive role in the zeolite NaP1 synthesis, and a Na₂SiO₃ dosage of 30 wt% is adopted for zeolite NaP1 fabrication. A NaOH concentration of 1 M is sufficient for zeolite NaP1 synthesis. Additionally, the zeolite NaP1 content is found to obviously increase with increasing MH time from 0.5 h to 2 h. To demonstrate the feasibility of the method provided in this study, the optimal experimental condition is employed for various MSWI FAs, and zeolite NaP1 and analcime are fabricated successfully. The leachability of heavy metals for the synthetic products was evaluated, which met the requirements for pollution control. The BET surface area and total pore volume of zeolite NaP1 fabricated at optimal condition are 61.42 m²/g and 0.44 cm³/g, respectively. The adsorption capacity of zeolite NaP1 for Cu²⁺ ion and methylene blue are determined to be 84.65 mg/g and 84.55 mg/g, respectively, indicating zeolite NaP1 is a potential adsorbent for cation ion and dyes. This study provides an environmentally friendly scheme for the utilization of MSWI FA.

Low intensity focused ultrasound: a new prospect for the treatment of Parkinson's disease

Background: As a chronic and progressive neurodegenerative disease, Parkinson's disease (PD) still lacks effective and safe targeted drug therapy. Low-intensity focused ultrasound (LIFU), a new method to stimulate the brain and open the blood-brain barrier (BBB), has been widely concerned by PD researchers due to its non-invasive characteristics.Methods: PubMed was searched for the past 10 years using the terms 'focused ultrasound', 'transcranial ultrasound', 'pulse ultrasound', and 'Parkinson's disease'. Relevant citations were selected from the authors' references. After excluding articles describing high-intensity focused ultrasound or non-Parkinson's disease applications, we found more than 100 full-text analyses for pooled analysis.Results: Current preclinical studies have shown that LIFU could improve PD motor symptoms by regulating microglia activation, increasing neurotrophic factors, reducing oxidative stress, and promoting nerve repair and regeneration, while LIFU combined with microbubbles (MBs) can promote drugs to cross the BBB, which may become a new direction of PD treatment. Therefore, finding an efficient drug carrier system is the top priority of applying LIFU with MBs to deliver drugs.Conclusions: This article aims to review neuro-modulatory effect of LIFU and the possible biophysical mechanism in the treatment of PD, summarize the latest progress in delivering vehicles with MBs, and discuss its advantages and limitations.

Improving stabilization/solidification of MSWI fly ash with coal gangue based geopolymer via increasing active calcium content

Municipal solid waste incineration fly ash (MSWI FA) is categorized as a hazardous waste, which demands environmentally acceptable treatment due to its easy leachability toxic of heavy metals. This study investigated an innovative and improved method for stabilization/solidification (S/S) of MSWI FA with coal gangue based geopolymer by the addition of active calcium content. The specimen with addition of calcium oxide up to 10 % reached the compressive strength of 2.14 MPa at 28 d. The addition of 30 % calcium oxide resulted in the highest immobilization efficiencies of Cd (98.96 %) and Pb (99.19 %). X-ray Diffraction (XRD), Fourier Transform Infrared Spectrometry (FTIR), Scanning Electron Microscope (SEM), and thermogravimetric (TG) analysis indicated the generation of calcium-containing hydration products was promoted after the improvement of calcium content in binder. Heavy metals were stabilized through the chemical adsorption and ions exchange of amorphous hydration products. On the whole, this study illustrated that the incorporation of active calcium content can improve efficiently S/S of hazardous ash waste such as MSWI FA.

Analysis of clinical features, treatment, and prognosis of primary Xlymphoepithelioma-like carcinoma of the lung

OBJECTIVE

Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare lung malignancy occurring most frequently in young non-smokers from Southeast Asia. Given its low incidence, PPLELC clinical features, treatment methods, and the factors affecting its prognosis remain elusive. To date, PPLELC data are mainly derived from clinical case reports, and no cohort studies are available. Therefore, we retrospectively analyzed a group of PPLELC cases and summarized the clinical features of patients, treatment responses, and the factors affecting patient prognosis.

PATIENTS AND METHODS

A total of 91 patients having primary pulmonary lymphoepithelioma-like carcinoma were recruited in this study. These included sex, age, place of birth, smoking history, pre-treatment symptoms, tumor location, tumor markers, maximum tumor diameter, treatment regimen, lymph node presence metastasis after an operation, pathological picture, immunohistochemistry, genetic findings, and tumor stage grading. We determined the overall survival (OS), progression-free survival (PFS), basic clinical characteristics, treatment option, treatment response, and recurrence pattern among the patients. In addition, we understood the influence of sex, age, tumor, nodes, and metastases (TNM) stage, tumor size, and surgery over patient prognosis.

RESULTS

Primary pulmonary lymphoepithelioma-like carcinoma is more common among young non-smokers, with a slightly higher incidence in women than in men. The expression of Epstein-Barr virus-encoded small RNA (EBER), pancytokeratin (PCK), Cytokeratin 5/6 (CK5/6), and tumor protein 63 (P63) was positive in immunohistochemistry. Serum cytokeratin 19 fragment antigen (CYFRA21-1) and Epstein-Barr DNA (EB-DNA) could be used as markers to diagnose primary pulmonary lymphoepithelioma-like carcinoma. TNM stage and surgery were independent prognostic factors.

CONCLUSIONS

Primary pulmonary lymphoepithelioma-like carcinoma is rare, showing a good prognosis.

Evaluation of the presence of SARS-CoV-2 in vaginal and anal swabs of women with omicron variants of SARS-CoV-2 infection

Objectives

The study aimed to determine whether SARS-CoV-2 Omicron variant could be detected in the vaginal fluid and anal swabs of reproductive-aged and postmenopausal women infected with SARS-CoV-2 Omicron variant.

Methods

Included in this study were 63 women who were laboratory confirmed as having SARS-CoV-2 Omicron variant infection and admitted to the responsible ward of Daping Hospital of at the National Exhibition and Convention Center(Shanghai) Makeshift Hospital from May 1–24, 2022.From them, vaginal and anal swabs were obtained with informed consent. The demographic and baseline clinical characteristics and the swab test results were analyzed.

Results

The 63 included patients ranged in age from 18 to 72 years with a median of 47.71 ± 15.21 years. Of them, 38 women (60.3%) were in their reproductive years. Most of the participants (77.8%) were healthy without significant underlying diseases. Fourteen patients (22.2%) had asymptomatic infection and the remaining 49 (77.8%) had mild infection. The upper respiratory tract symptoms including cough (40/63.5%) and sore throat (18/28.6%)were the most common clinical manifestations of these mildly infected patients. Only 5 patients (7.8%) had gastrointestinal (GI) symptoms, including simple diarrhea in 4 patients, and diarrhea with vomiting in one patient. Pharyngeal,vaginal and anal swabs were collected simultaneously from all 63 patients 8–16 (mean 11.25 ± 2.23) days after SARS-Cov-2 Omicron variant infection. The vaginal swabs were negative for SARS-CoV-2 in all 63 patients, and the anal swabs were positive in 4 patients (6.5%). The overall median hospitalization duration was 16.73 ± 3.16 days.

Conclusion

The results of the present study suggest that there is a low possibility of SARS-Cov-2 Omicron variant transmission via the digestive tract and vaginal fluid. The correlation between the GI symptoms and the presence of viral RNA in anal swabs is uncertain.

[Clinical characteristics in patients with persistent positive pharyngeal swab of omicron variant and analysis on nucleic acid testing of anal swabs]

OBJECTIVE

To analyze the clinical characteristics in patients with persistent positive pharyngeal swab of 2019 novel coronavirus Omicron variant and results of nucleic acid testing of anal swabs to provide basis for prevention and control measures.

METHODS

This study included 93 patients whose pharyngeal swab nucleic acid test were persistent positive and admitted to the ward of Daping Hospital in the National Exhibition and Convention Center (Shanghai) Makeshift Hospital from May 1 to May 24, 2022. The gender, age, underlying diseases, vaccination status, clinical symptoms, interval between infection onset and anal sampling, length of hospital stay, the nucleic acid test result of pharyngeal swabs and anal swabs and the time turning negative were collected and analyzed.

RESULTS

The age of 93 patients ranged from 8 to 72 years old with a median of (46.0±16.0) years old. Among them, 30 cases (32.3%) were male and 63 cases (67.7%) were female. Sixty-five patients (69.9%) received 2-3 shots of vaccine, 2 patients (2.1%) received 1 shot, and 26 patients (28.0%) did not receive any vaccination. Twenty patients (21.5%) had underlying diseases, of which hypertension (13 cases, 14.0%) and type 2 diabetes mellitus (6 cases, 6.5%) were the most common. Twenty-four patients (25.8%) had asymptomatic infection and the rest (69 cases, 74.2%) had mild symptoms. Cough (50 cases, 53.8%) and sore throat (28 cases, 30.1%) were the most common clinical manifestations of the upper respiratory tract in these patients. Only 6 patients (6.5%) had gastrointestinal symptoms (including diarrhea in 5 patients and diarrhea with vomiting in 1 patient). Pharyngeal and anal swabs were collected simultaneously from all 93 patients at 8-16th days [(11.55±2.27) days] after 2019 novel coronavirus Omicron variant infection. The pharyngeal swabs were positive in 79 patients (85.0%) and the anal swabs were positive in 5 patients (5.4%). The time of pharyngeal swabs turning negative was (14.7±2.9) days, and that of anal swab turning positive was (14.2±1.9) days. The median length of hospital stay was (16.7±2.9) days.

CONCLUSIONS

In patients with persistent positive nucleic acid of the 2019 novel coronavirus Omicron variant, there were more mild infection than asymptomatic. The upper respiratory tract symptoms such as cough and sore throat were the most. The likelihood of transmission of 2019 novel coronavirus Omicron variant through the digestive tract may be low. The correlation between gastrointestinal symptoms and 2019 novel coronavirus Omicron variant RNA in the digestive tract is uncertain.

Case Report: A case of uterine leiomyosarcoma metastasized to the vena cava, excised with the aid of preoperative CT three-dimensional imaging

Leiomyosarcoma of the uterus (ULMS) is a rare malignant tumor originating from embryonic mesenchymal cells. ULMS tends to metastasize to the lungs, lymph nodes, liver, and bone. Computed tomography three-dimensional (CT 3D) imaging is an advanced diagnostic technique that can track the vessels and their relationships with tumors and reveal the invasion of vessels, including small vessels, around tumors in any slice. Here, we describe a case in which ULMS extended to the retrohepatic inferior vena cava. To date, no report has described resection of metastatic ULMS of the vena cava through supplemental CT 3D imaging. Our patient presented with right lumbar abdominal pain as the main symptom. After using CT 3D reconstruction to accurately assess the relationship between the tumor and the surrounding organs and blood vessels before the operation, the operation was successfully completed through multidisciplinary surgical collaboration.

Study of Corrosion Kinetic Measurement and Morphology Observation of Superheater Tube 12Cr1MoV Alloy in Simulated MSWI Flue Gas Containing Varied HCl or SO2 Concentrations

Severe corrosion to superheater tubes at high temperatures was gained virtually by gaseous corrosion media, such as HCl and SO₂, in the municipal solid waste incineration flue gas. To clarify the effect of varying concentrations of HCl and SO₂ in the oxidizing atmosphere on the corrosion of 12Cr1MoV, a commercial alloy used in superheaters, two series of corrosion tests under simulated flue gas were performed. Both the corrosion kinetics and corrosion morphology were measured in this work. The results of the present study demonstrated that the addition of HCl was more corrosive than that of SO₂ under an oxidizing atmosphere. The increased HCl concentration had an accelerating effect on the corrosion rate, but the relation between the two was not linear. In contrast, SO₂ exhibited a negligible or even inhibitory effect on corrosion. Both series of test results consistently proved that the temperature had a significant influence on the corrosion of 12Cr1MoV alloy, in particular at 580 °C.

AB0206 STUDY ON THE SIGNIFICANCE OF SERUM COMPLEMENT C5 IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Recent studies have pointed out that complement system activation is a major alteration in early atherosclerotic plaques, and complement C5 has promising value as a novel circulating biomarker of atherosclerosis, but the relationship between C5 and carotid atherosclerotic (CAS) plaque in rheumatoid arthritis (RA) is still unclear.

Objectives

To investigate the clinical significance of serum complement C5 and the association with CAS plaque in patients with RA．

Methods

143 patients with RA were included in the study, and 46 cases with age- and sex- matched healthy physical examination without RA or CAS plaque served as a normal control. All RA patients were divided into RA with CAS plaque group and RA without CAS plaque group according to the presence or absence of plaque formation in the carotid artery. The subject’s demographic data, laboratory investigations and serum samples were collected. Body mass index (BMI) and Disease Activity Score 28-joint counts (DAS28) were calculated. Glucocorticoid and DMARDS use were recorded in the past 3 months. ELISA method was used to determine the concentration of complement C5 in the serum of each participation. CAS plaque was determined by color Doppler ultrasound.

Results

Serum complement C5 in RA group was significantly lower than that in control group (P<0.05), whereas C5 level in RA with CAS plaque group was significantly higher than that in RA without CAS plaque group (P<0.05). In RA group, serum C5 level was positively correlated with CAS plaque, high-sensitivity C-reactive protein (hs-CRP) and fibrinogen (FIB) (r=0.204, P=0.017; r=0.225, P=0.009; r=0.186, P=0.029;). In addition, there was no significant correlation between serum C5 and sex, age, BMI, course of disease, DAS28, lipid profile (TG, serum triglyceride; TC, total cholesterol; LDLC, low density lipoprotein cholesterol; HDLC, high density lipoprotein cholesterol; TC/HDLC; LDLC/HDLC), immune markers (RF, rheumatoid factor; anti-CCP, anti-cyclic citrullinated peptide antibodies), cytokine (IL-6, Interleukin-6; TNF-α, Tumor necrosis factor-α), erythrocyte sedimentation rate (ESR) (all P>0.05), or drug therapy (all P>0.05).

Conclusion

C5 may be a novel circulating marker of atherosclerosis in RA patients, it might promise to assist in risk stratification for cardiovascular disease in the future.

References

[1]Martínez-López D, et al. Complement C5 Protein as a Marker of Subclinical Atherosclerosis. J Am Coll Cardiol. 2020 Apr 28;75(16):1926-1941.

Disclosure of Interests

None declared

Bedside critical ultrasound as a key to the diagnosis of obstructive atelectasis complicated with acute cor pulmonale and differentiation from pulmonary embolism: A case report

Acute attack of dyspnea may be combined with acute cor pulmonale (ACP). Rapid and accurate identification of the etiology of ACP is the key to its diagnosis and treatment. Echocardiography is a better imaging tool in the assessment of right ventricular function. Under the guidance of the theory of cardiopulmonary interaction, ultrasonography can detect lung lesions, which causes ACP. We report the case of a 67-year-old man who received mechanical ventilation for acute respiratory failure. Right ventricular dysfunction was detected by echocardiography. Lung ultrasound showed a high risk of pulmonary embolism. However, obstructive atelectasis should not be ruled out after increasing back area ultrasonography. To avoid pitfalls, combined cardiac and lung ultrasound should be used carefully and strictly.

AB1279 POOR QUALITY OF LIFE AND REDUCED WORK PRODUCTIVITY IN EUROPEAN PATIENTS WITH DERMATOMYOSITIS AND POLYMYOSITIS: FINDINGS FROM A SYSTEMATIC LITERATURE REVIEW

Background

Dermatomyositis (DM) and polymyositis (PM) are rare heterogenous systemic autoimmune disorders of the skin, muscles, and other organs with few effective treatment options available. They are described as devastating diseases but the full impact on patients’ lives in Europe is not well understood.

Objectives

To systematically review and summarize evidence on humanistic burden of disease in patients with DM and PM in Europe to better understand patient-relevant aspects of disease and key domains of life impacted by DM and PM in the European setting.

Methods

A systematic literature review (SLR) was conducted in MEDLINE and Embase databases to identify studies in children and adults with DM and PM, published in the English language between Jan 1, 2011, and Apr 28, 2021. Only primary studies enrolling 10 or more patients were included, irrespective of country or region. Each eligible article was independently reviewed by two reviewers. The title and study abstracts were reviewed to assess eligibility for full-text review. The topics of interest were clinical, humanistic, and economic burden of disease, as well as current management and unmet needs in DM and PM. Information on geographic scope was extracted from the papers of included studies. The current abstract summarizes SLR results on humanistic burden of DM and PM in European patients.

Results

A total of 2,967 non-duplicated publications were retrieved from medical databases and analyzed against pre-defined study selection criteria. There were 2,574 records excluded at title and abstract screening. Remaining 393 records were analyzed in the full text with 208 papers considered relevant. Additional 21 papers were identified from searching reference list of relevant studies and conference proceedings. In total, 222 studies described in 229 publications were included in data abstraction. Among 43 studies conducted across 14 European countries, 12 studies evaluated health-related quality of life (HRQoL) and work productivity in patients with DM and PM. In 6 studies, patients received standard of care therapy. Six studies enrolled adults with DM and PM and 6 were conducted in patients with juvenile onset of DM. There were 6 cross-sectional analyses, 4 longitudinal cohort studies, 2 case-control studies, with sample size ranging from 11 to 246 patients. Adults with DM and PM had significantly worse HRQoL across multiple domains of 36-Item Short Form Survey (SF-36) compared to controls from general population, with a strong negative impact of muscle weakness on physical functioning. Patients reported high difficulties in performing leisure time activities, moving around and work as indicated by median scores of 4-5 points in a 7-point Myositis Activity Profile (MAP). Reduced grip force in DM and PM adults was significantly associated with worse performance in domestic activities in the MAP assessment (p<0.05). In women with DM and PM, poor grip force additionally impacted vitality and mental health as measured by SF-36 (p<0.05). There were no associations between grip force and any SF-36 domain in men. Approximately 60% of adult patients rated their ability to work as “poor” or “less good” according to the Work Ability Index, 68% of patients had more than one week of sick leave in the past year, and 20.8% of them were permanently not able to work for at least 2 years. Children and adolescents with DM had impaired physical and psychosocial functioning compared to healthy norms with 40% of individuals showing increased emotional distress requiring in-depth psychological assessment.

Conclusion

European patients with DM and PM experience a muscle weakness that has a detrimental impact on HRQoL, daily activities and ability to work. Similar disease impact on HRQoL was reported in patients in North America. These findings suggest a need for a novel therapy that will restore physical functioning in patients with DM and PM.

Disclosure of Interests

Jens Schmidt Speakers bureau: Euroimmun, CSL Behring, Consultant of: Alnylam, Argenx, Biotest, CSL Behring, Kezar Life Sciences, LFB, Novartis, Octapharma, UCB, Grant/research support from: CSL Behring, Novartis, Konrad Pisarczyk Consultant of: Kezar Life Sciences, Richard Leff Shareholder of: Kezar Life Sciences, Consultant of: Kezar Life Sciences, Kiruthi Palaniswamy Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Eunmi Park Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Li Long Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences

AB1277 POOR LONG-TERM OUTCOMES AND SUBSTANTIAL BURDEN OF COMORBIDITIES IN EUROPEAN PATIENTS WITH DERMATOMYOSITIS/POLYMYOSITIS: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

Background

Dermatomyositis (DM) and polymyositis (PM) are rare heterogenous systemic autoimmune disorders of the skin, muscles and other organs that may have a devastating impact on patients’ lives. Despite various therapies used in clinical practice, a notable proportion of patients seem not to achieve sustainable remission. There is a need to better understand long-term outcomes and comorbidities in patients with DM/PM in Europe.

Objectives

To systematically review and summarize evidence on clinical burden of disease in patients with DM/PM in Europe.

Methods

A systematic literature review (SLR) was conducted in MEDLINE and Embase databases to identify studies in children and adults with DM/PM, published in the English language between 2011 and 2021. Primary studies enrolling 10 or more patients were included, irrespective of country or region. Each eligible article was independently reviewed by two reviewers. The title and study abstracts were reviewed to assess eligibility for full-text review. The current abstract summarizes SLR results on the long-term outcomes and comorbidities in patients with DM/PM in Europe.

Results

A total of 2,967 non-duplicated publications were retrieved from medical databases and analyzed against pre-defined study selection criteria. There were 2,574 records excluded at title and abstract screening. Remaining 393 records were analyzed in the full text with 208 papers considered relevant. Additional 21 papers were identified from searching reference list of relevant studies and conference proceedings. In total, 222 studies (229 publications) were included in data abstraction. Among 43 studies conducted across 14 European countries, 23 studies evaluated long-term outcomes of disease and burden of comorbidities. There were 14 longitudinal cohort studies, 7 cross-sectional analyses and 2 case-control studies. Only 29-44% of DM/PM adults achieved remission. Between 38% and 62% of adults with DM/PM required at least 3 different medications, suggesting inadequate response to initial and subsequent regimens. During a mean follow-up of 13.9 years, 69% patients with JDM had polycyclic or chronic disease characterized by periods of remission and recurrence or by permanently active disease for more than 2 years after diagnosis. A notable proportion of children (60.4%) showed evidence of damage in at least one body organ and 13-20% of patients had complications such as calcinosis, lipodystrophy, or muscle atrophy. Adults with DM/PM often suffered from interstitial lung disease (16-66%), serious infections leading to hospitalization or death (21-26.7%), and cardiovascular disorders (CVDs) (19-71%). Compared to age and gender matched controls without DM, patients with DM had 16-times higher risk of venous thromboembolism (HR=16.44, 95% CI: 7.54-35.86). Incidence of coronary heart disease, hemorrhagic stroke, or ischemic stroke during 10-year follow-up was approximately 1.5- to 2-times higher in DM/PM adults relative to general population. Multiple studies reported high rates of any malignancy in DM adults (7.5-33%) and in PM adults (8-11.7%). During approximately 24,000 patient-years of follow-up, adults with DM/PM had more than 4-times higher incidence of lung cancer compared to general population that also was one of the highest incidences among multiple other autoimmune diseases. Long-term prognosis in DM/PM was poor with 20-year survival below 70%. The most common causes of deaths were pulmonary-related, malignancies, and cardiac complications. Mortality due to lung cancer was more than 4-times higher than in general population (standardized mortality ratio=4.17, 95% CI: 3.03-5.60).

Conclusion

European patients with DM/PM suffer from substantial burden of comorbidities including serious infections, malignancies and CVDs that lead to poor long-term outcomes. A notable proportion of adult and juvenile patients do not achieve sustainable remission or experience relapse indicating high unmet need.

Disclosure of Interests

Jiří Vencovský Speakers bureau: Abbvie, Biogen, Boehringer, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Werfen, Consultant of: Abbvie, Argenx, Boehringer, Eli Lilly, Gilead, Octapharma, Pfizer, UCB, Grant/research support from: Abbvie, Konrad Pisarczyk Consultant of: Kezar Life Sciences, Richard Leff Shareholder of: Kezar Life Sciences, Consultant of: Kezar Life Sciences, Eunmi Park Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Kiruthi Palaniswamy Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Li Long Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences.

[Observation of PD-1+CXCR5+CD4+T lymphocyte and sPD-1 levels in HBeAg positive chronic hepatitis B virus carriers treated with entecavir]

Objective: To dynamically observe the clinical efficacy of entecavir and the changes of PD-1⁺CXCR5⁺CD4⁺T lymphocytes and sPD-1 levels in peripheral blood of HBeAg-positive chronic hepatitis B virus carriers treated with entecavir, and further explore its clinical significance. Methods: There were 31 cases of chronic hepatitis B virus carriers in the treatment group (A), 32 cases of chronic hepatitis B virus carriers in the treatment group (B), and 15 cases of chronic hepatitis B virus carriers in the non-treatment group (C).Three groups peripheral blood samples and clinical data at 0, 24 and 48 weeks were collected and compared. PD-1⁺CXCR5⁺CD4⁺T lymphocytes were detected by flow cytometry, and the level of sPD-1 was detected by enzyme-linked immunosorbent assay. ANOVA and Spearman correlation analysis were performed on the measurement data among the three groups. Results: At week 0, the serum levels of HBsAg, HBeAg and HBV DNA were significantly higher in groups A and C than group B. PD-1⁺CXCR5⁺CD4⁺T lymphocytes in peripheral blood were significantly higher in group B (4.70%±1.58%) than group A (3.25%±1.01%) and group C (2.77%±0.67%) (F=16.65, P<0.05). There was no significant difference between group A and group C (P>0.05). Peripheral blood sPD-1 in group B [(1 866.62±1 472.70) pg/ml] was significantly higher than group A [(824.86±538.66) pg/ml] and group C [(618.19±602.62) pg/ml] (F=10.95, P<0.05). There was no significant difference between group A and group C (P>0.05). At 48 weeks, the serum HBsAg did not decrease significantly in groups A and C than baseline (P>0.05), but were significantly higher than group B (P<0.05). Serum HBeAg levels were decreased significantly in groups A and B than baseline (P<0.05). <0.05), but group A was significantly higher than group B (P<0.05), and there was no significant difference between group A and group C (P>0.05). Serum HBV DNA level was significantly lower in groups A and B than group C (P<0.05), and there was no significant difference between group A and group B (P>0.05). Peripheral blood PD-1⁺CXCR5⁺CD4⁺T lymphocytes were significantly lower in Group A (1.56%±0.73%) and group B (1.32%±0.43%) than group C (2.64%±0.85%) (P<0.05). Peripheral blood sPD-1 were significantly lower in group A [(289.05±215.86) pg/ml] and group B [(236.01±173.92) pg/ml] than group C [(650.34±598.46) pg/ml] (P<0.05). There was no significant difference between group A and group B. Correlation analysis results: In group A at 48 weeks, the decreased level of PD-1⁺CXCR5⁺CD4⁺T lymphocyte ratio had no correlation with the decreased level of HBsAg and HBV DNA, but was positively correlated with the decreased level of HBeAg (r=0.376, P<0.05). The decreased level of sPD-1 had no correlation with the changes of HBsAg, but was positively correlated with the decreased levels of HBeAg and HBV DNA (r=0.598 and 0.384, P<0.05). In group B at 48 weeks, the decreased levels of PD-1⁺CXCR5⁺CD4⁺T lymphocytes and sPD-1 were positively correlated with the decreased levels of HBsAg, HBeAg, and HBV DNA (P<0.05). Conclusion: Hepatitis B virus replication and expressions in HBeAg-positive chronic hepatitis B virus carriers were significantly inhibited after 48 weeks of antiviral treatment, which is related not only to entecavir treatment, but also to the immunological mechanism involved in sPD-1. Moreover, the inhibition of HBeAg expression is associated with a decrease in the number and/or activity of PD-1⁺CXCR5⁺CD4⁺T lymphocytes.

Dual-source dual-energy computed tomography-derived quantitative parameters combined with machine learning for the differential diagnosis of benign and malignant thyroid nodules

Background

This study aimed to investigate the ability of quantitative parameter-derived dual-source dual-energy computed tomography (DS-DECT) combined with machine learning to distinguish between benign and malignant thyroid nodules.

Methods

Patients with thyroid nodules and pathological surgical results who underwent preoperative DS-DECT were selected. Quantitative parameter-derived DS-DECT was applied to classify benign and malignant nodules. Then, machine learning and binary logistic regression analysis models were constructed using the DS-DECT quantitative parameters to distinguish between benign and malignant nodules. The receiver operating characteristic curve was used to assess the diagnostic performance. The DeLong test was used to compare the diagnostic efficacy.

Results

One hundred and thirty patients with 139 confirmed thyroid nodules were involved in the study. The malignant group had a significantly higher iodine concentration_nodule (arterial phase) (P=0.001), normalized iodine concentration (arterial phase) (P=0.002), iodine concentration difference (P<0.001), spectral curve slope (nonenhancement) (P=0.007), spectral curve slope (arterial phase) (P=0.001), effective atomic number (nonenhancement) (P<0.001), and effective atomic number (arterial phase) (P=0.039) than the benign group. The binary logistic regression analysis model had an AUC (area under the curve) of 0.76, a sensitivity of 0.821, and a specificity of 0.667. The machine learning model had an AUC of 0.86, a sensitivity of 0.822, specificity of 0.791 in the training cohort, an AUC of 0.84, a sensitivity of 0.727, and specificity of 0.750 in the testing cohort.

Conclusions

Multiple quantitative parameters of DS-DECT combined with machine learning could differentiate between benign and malignant thyroid nodules.

Comparison of MSWI fly ash from grate-type and circulating fluidized bed incinerators under landfill leachate corrosion scenarios: the long-term leaching behavior and speciation of heavy metals

In this study, the long-term leaching behaviors of Cd, Cr, Cu, Ni, Pb, and Zn in municipal solid waste incineration (MSWI) fly ash samples from grate-type (GT) and circulating fluidized bed (CFB) incinerators were investigated and compared under the simulated landfill leachate corrosion scenario, which was determined to be more severe than the acid rain corrosion scenario. The total heavy metal contents showed increasing hierarchies of Ni<Cr<Cd<Cu<Pb<Zn in the GT fly ash samples and Cd<Ni<Cr<Pb<Cu<Zn in the CFB fly ash samples. During the leaching processes, all heavy metals followed the two-stage leaching mode, including quick accumulation in stage 1 and then stable release in stage 2. The heavy metals with the highest accumulative leaching amounts were Cd, Pb, and Zn in GT fly ash and Cr, Cu, and Ni in CFB fly ash. In the landfill leachate corrosion scenario, Cd and Cr showed cationic patterns while Pb, Zn, and Cu showed amphoteric patterns. The leaching of Cd, Ni, and Cr arose from the dissolution of the salts they formed (solubility control), while the leaching of Cu, Pb, and Zn was controlled by the Ca-bearing compounds (sorption and precipitation control). A large difference in Pb leaching was observed: the cumulative leaching amount of GT fly ash (707.59-3072.36 mg/kg) was an order of magnitude higher than that of CFB fly ash (22.47-407.314 mg/kg), as a result of the higher primary content and larger proportion of the residual fraction in CFB fly ash. The acid-soluble and reducible fractions exhibited higher percentages than those of other fractions representing higher levels of environmental toxicity and risk. Therefore, more emphasis should be placed on the conversion of bioavailable fractions into stable fractions for the stabilization and utilization of MSWI fly ash.

Nrf2 Inhibits the Progression of Parkinson’s Disease by Upregulating AABR07032261.5 to Repress Pyroptosis

Objective

Parkinson’s disease (PD) is associated with dysregulated neural cell death, such as pyroptosis, but its regulatory mechanisms are poorly understood. This study investigated roles of nuclear factor E2-related factor 2 (Nrf2) in regulating pyroptosis and PD development.

Methods

Cellular and rat PD models established by 6-OHDA exposure were subjected to Nrf2 overexpression. Neurobehavioral functions were assessed by the traction test, Morris Water Maze, and open field test. Cell proliferation was analyzed by MTS assay, while flow cytometry was applied to quantify levels of reactive oxygen species (ROS) and apoptosis. Nissl bodies in rat brains were detected by Nissl staining, and cell apoptosis in brain tissues was assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling. Differential expression of lncRNA and mRNA was characterized by deep sequencing.

Results

A cellular PD model was successfully established by inducing PC12 cell differentiation with nerve growth factor-β and exposing differentiated cells to 6-OHDA. Cells exhibited significantly increased ROS levels, enhanced pyroptosis, and inhibited Nrf2 phosphorylation. The rat PD model exhibited impaired muscle strength, increased pyroptosis, and repressed Nrf2 phosphorylation. Nrf2 overexpression effectively repressed pyroptosis in both cellular and rat PD models. Marked alterations of lncRNA and mRNA profiles were induced by Nrf2 overexpression in the cellular PD model, which involved multiple signaling pathways. Silencing of the lncRNA AABR07032261.5 significantly promoted pyroptosis in the cellular PD model.

Conclusion

Nrf2 suppressed PD pathogenesis in cellular and animal models by promoting AABR07032261.5, which repressed pyroptosis.

MicroRNA-21 protects against sepsis-induced acute lung injury by targeting phosphatase and tensin homolog in mice

Introduction: Sepsis can cause acute lung injury (ALI), one of the leading causes of death in critically ill patients. The underlying mechanisms of sepsis-induced acute lung injury include excessive inflammation, oxidative stress, cell apoptosis, pulmonary edema, and lung tissue dysfunction. Recent studies have shown that miRNA-21 (miR-21) plays a vital role in sepsis-induced acute kidney injury. Relatively few studies have focused on the protective effects of ALI. This study aimed to determine the potential role of miR-21 in sepsis-induced ALI.

Methods: We performed quantitative real-time polymerase chain reaction in a septic mouse model induced by cecal ligation and puncture (CLP) and found that miR-21 expression was upregulated. We then transfected the miR-21 precursor to upregulate miR-21 expression and miR-21 inhibitor to downregulate miR-21 expression. The sham group was exposed only to the cecum. ALI was induced by CLP, and the pre-miR-21+ALI and anti-miR-21+ALI groups were treated with miR-21 precursor or miR-21 inhibitor in the caudal vein before CLP. Pre-miR-21+ALI+PTEN inhibition (Pre-miR-21+ALI+PI) and anti-miR-21+ALI+PTEN inhibition (Anti-miR-21+ALI+PI) groups were treated with PTEN inhibition into the caudal vein after miR-21 transfection. Inflammatory cytokines, oxidative stress indicators, lung tissue cell apoptosis, oxygenation index (OI), lung wet/dry weight ratio, and lung pathological changes in the lung were observed in each group.

Results: Compared with ALI mice, inflammatory response, oxidative stress indicators, lung tissue cell apoptosis, and the degree of lung injury were remarkably alleviated in Pre-miR-21+ALI mice and aggravated in Anti-miR-21+ALI mice. Western blot analysis showed that phosphatase and tensin homolog (PTEN) protein expression was decreased in CLP-treated mics. PTEN protein expression was decreased in the Pre-miR-21+ALI group but increased in the Anti-miR-21+ALI group. Moreover, the effect of miR-21 on anti-inflammatory, anti-oxidative stress, and anti-apoptosis enhanced after PTEN inhibition.

Conclusion: This study revealed that miR-21 has a protective effect in sepsis-induced ALI by regulating PTEN in mice.

1521 Oral Foregut Duplication Cyst in A Neonate: A Case Report and Review of The Literature

A four-day-old neonate was referred to the Oral and Maxillofacial Surgery department by the Paediatric medical team regarding a cystic lesion associated with the child’s lingual frenulum. The lesion appeared to be affecting feeding causing a potential failure to thrive.

An MRI showed a 22 x 14 x 17 mm thin-walled oval cystic structure within the midline of the tongue/floor of the mouth. The decision was made with the family to surgically excise the lesion under a general anaesthetic. The histopathology results demonstrated the cyst to be lined with both gastric surface mucus cells and ciliated respiratory-type epithelium.

The patient was diagnosed with having an Oral Foregut Duplication Cyst (OFDC), also known as a lingual choristoma, enteric duplication cyst or heterotopic gastrointestinal cyst of the oral cavity. OFDCs are benign developmental anomalies that contain foregut derivatives. The cyst linings can contain gastrointestinal, respiratory, squamous or mixed cell types. There are only approximately 58 cases reported in the literature, demonstrating the rarity of these lesions.

OFDCs can be asymptomatic but in some neonates, they can present with difficulties feeding, swallowing and even has been shown to cause airway obstruction. If left in situ an OFDC can potentially go on to hinder speech development.

Although rare, OFDCs should be considered in a differential diagnosis of congenital oral lesions and in particular those of the anterior floor of mouth and tongue. With the use of pre-op imaging to help planning, surgical excision is both diagnostic and therapeutic.

Pituitary P62 deficiency leads to female infertility by impairing luteinizing hormone production

P62 is a protein adaptor for various metabolic processes. Mice that lack p62 develop adult-onset obesity. However, investigations on p62 in reproductive dysfunction are rare. In the present study, we explored the effect of p62 on the reproductive system. P62 deficiency-induced reproductive dysfunction occurred at a young age (8 week old). Young systemic p62 knockout (p62-/-) and pituitary-specific p62 knockout (p62flox/flox αGSUcre) mice both presented a normal metabolic state, whereas they displayed infertility phenotypes (attenuated breeding success rates, impaired folliculogenesis and ovulation, etc.) with decreased luteinizing hormone (LH) expression and production. Consistently, in an infertility model of polycystic ovary syndrome (PCOS), pituitary p62 mRNA was positively correlated with LH levels. Mechanistically, p62-/- pituitary RNA sequencing showed a significant downregulation of the mitochondrial oxidative phosphorylation (OXPHOS) pathway. In vitro experiments using the pituitary gonadotroph cell line LβT2 and siRNA/shRNA/plasmid confirmed that p62 modulated LH synthesis and secretion via mitochondrial OXPHOS function, especially Ndufa2, a component molecule of mitochondrial complex I, as verified by Seahorse and rescue tests. After screening OXPHOS markers, Ndufa2 was found to positively regulate LH production in LβT2 cells. Furthermore, the gonadotropin-releasing hormone (GnRH)-stimulating test in p62flox/flox αGSUcre mice and LβT2 cells illustrated that p62 is a modulator of the GnRH-LH axis, which is dependent on intracellular calcium and ATP. These findings demonstrated that p62 deficiency in the pituitary impaired LH production via mitochondrial OXPHOS signaling and led to female infertility, thus providing the GnRH-p62-OXPHOS(Ndufa2)-Ca2+/ATP-LH pathway in gonadotropic cells as a new theoretical basis for investigating female reproductive dysfunction.

Apatinib treatment efficiently delays biochemical-only recurrent ovarian cancer progression

Background

Biochemical recurrence is defined as only rising CA-125 but no radiographic evidence of disease; noteworthily, it generally precedes the onset of clinical evidence. Now treatment strategies of biochemical recurrence ovarian cancer (OC) remain controversial. Apatinib as monotherapy or in combination with other chemotherapeutic agents has shown its effect in the treatment of some advanced malignancies. In our study, we focused on the efficacy of apatinib in recurrent OC, especially its clinical activity in biochemical-only recurrent OC patients.

Methods

We retrospectively analyzed clinical material of 41 recurrent patients who had received apatinib monotherapy or apatinib plus chemotherapy between June 2016 and August 2018. Apatinib was administered at a 500mg daily dose. Response was determined according to measurable disease or serum carbohydrate antigen (CA)-125 levels. Progression-free survival (PFS) was estimated by Kaplan–Meier method.

Results

All patients were evaluable, 19 (46.34%) had biochemical relapse and 22 (53.66%) had clinical relapse. The objective response rate (ORR) and disease control rate (DCR) in the overall population were 31.71% and 78.05%, respectively. The median PFS was 7 months (95% confidence interval 5.43–8.57). And in patients with biochemical-only relapse, the median PFS was 6 months, with ORR of 26.32% and DCR of 89.47%.

Conclusions

Apatinib is a well-tolerated and effective agent to delay clinical progression of patients with biochemical-only recurrent OC. More important, our study shows the promising prospect for treating OC patients with asymptomatic biochemical relapse.

AB0756 IMMUNE-MEDIATED BASIS FOR A PHASE 2A CLINICAL STUDY COMPARING RILZABRUTINIB VS GLUCOCORTICOIDS IN RITUXIMAB-REFRACTORY PATIENTS WITH IGG4-RELATED DISEASE

Background:

IgG4-related disease (IgG4-RD) is an immune-mediated disorder causing fibro-inflammatory lesions. Although the cause remains unknown, it may be driven by interactions between B lymphocytes and CD4+ cytotoxic and regulatory T cells and is characterized by an increase in short-lived plasmablasts, circulating antibodies, and macrophages. Standard therapy mainly includes glucocorticoids (GC), limited by toxicity with long-term use (> 6 mo), and to a lesser extent, immunosuppressives (eg, rituximab). Bruton tyrosine kinase (BTK) plays an important role in the activation of multiple immune effector cells such as B cells, mast cells, eosinophils, basophils, monocytes/macrophages, and neutrophils. Dysregulation of the activation of these immune cells results in autoimmune inflammation, tissue damage, and development of fibrosis. Rilzabrutinib is a highly selective oral BTK inhibitor that targets multiple pathways of innate and adaptive immunity (with direct effects on B-cell and FcR pathways) and has the potential to inhibit antigen presentation to autoreactive T cells.

Objectives:

To provide the biological rationale for rilzabrutinib in IgG4-RD.

Methods:

Rilzabrutinib has been evaluated in biochemical, in vitro studies, and in vivo models of inflammatory diseases. Additional support is provided by the phase 2 trial for oral rilzabrutinib in patients with pemphigus vulgaris and the phase 2 trial for oral rilzabrutinib in patients with immune thrombocytopenia (ITP).

Results:

Rilzabrutinib inhibited the activity of BTK and B-cell receptor in B cells (IC50 5-123 nM) and Fc gamma receptor in IgG/Fc gamma receptor-stimulated monocytes (IC50 56 nM) and blocked IgG- and IgM-mediated antibody production in enriched B cells when stimulated in T-cell dependent (anti-CD40+IL-21) and T-cell independent (TLR-9/CpG and TNP-LPS) pathways. The impact of rilzabrutinib on innate cell pathways was further confirmed by significant dose-dependent inhibition of macrophage and neutrophil-driven passive rat Arthus reaction (P < 0.01 vs vehicle) and antibody-induced murine ITP (P < 0.05 vs vehicle). In a 12-week phase 2 pemphigus vulgaris trial, 54% of patients achieved the primary endpoint, control of disease activity (CDA) on low-dose corticosteroids by week 4, and 73% achieved it by week 12. In the phase 2 trial of ITP patients (median 6 prior therapies), rilzabrutinib 400 mg bid showed rapid and sustained improvement in platelet counts and only grade 1/2-related adverse events1. In responders, platelet counts increased as early as day 8, potentially due to innate immune mechanisms. Collectively, results in both B and innate immune cells provide an initial basis for evaluating rilzabrutinib in IgG4-RD. The ongoing phase 2a study (NCT04520451) is investigating rilzabrutinib 400 mg bid (+tapered GC) vs GC control (3:1) for 12 weeks in IgG4-RD patients refractory to rituximab. The primary objective is to evaluate the safety and ability of rilzabrutinib to induce GC-free remission at week 12. Coupled with known preclinical/clinical findings, mechanistic analyses in this ongoing IgG4-RD study will profile B and other immune cell effects pre-/post-rilzabrutinib dosing to enhance the clinical understanding of rilzabrutinib in IgG4-RD.

Conclusion:

Studies of rilzabrutinib that show beneficial effects on both B-cell and innate cell pathways provide support for its therapeutic role in immune-mediated diseases and for targeting the underlying pathophysiological effects of IgG4-RD. Effective and safe therapies that rapidly induce and maintain clinical responses, while minimizing the need for continuous GC treatment, remain an unmet need for patients with IgG4-RD.

References:

[1]Kuter et al. Res Pract Thromb Haemost. 2020;4(suppl 1): PB1318.

Disclosure of Interests:

Li Long Employee of: Principia Biopharma, a Sanofi Company, Matthew Baker: None declared, Mollie Carruthers: None declared, Alireza Meysami: None declared, Robert Spiera Consultant of: research funding and personal fees for consulting from Chemocentryx, Formation Biologics, Roche-Genentech, and Sanofi, Grant/research support from: research funding fees from BMS, Boehringer Ingelheim, Corbus, GSK, and Inflarx; personal fees from AbbVie, CSL Behring, GSK, and Janssen, Mamatha Reddy Employee of: Principia Biopharma, a Sanofi Company, Marianne Kavanagh Employee of: Principia Biopharma, a Sanofi Company, Michelle Francesco Employee of: Principia Biopharma, a Sanofi Company, Claire Langrish Employee of: Principia Biopharma, a Sanofi Company, Ann Neale Employee of: Principia Biopharma, a Sanofi Company, Puneet Arora Employee of: Principia Biopharma, a Sanofi Company, John H. Stone Consultant of: research funding and personal fees for consulting from Principia and Sanofi

AB0809 PADUA PREDICTION SCORE COMBINED WITH SERUM ALBUMIN FOR THE IDENTIFICATION OF VENOUS THROMBOEMBOLISM OF HOSPITALIZED PATIENTS IN THE DEPARTMENT OF RHEUMATOLOGY

Background:

Venous thromboembolism (VTE) includes thrombotic disease of venous system, but primarily includes lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE). Population-based epidemiological studies have shown an association between systemic autoimmune diseases and VTE[1]. The Padua prediction score(PPS) is a new 20-point risk assessment model proposed by Professor Barbar et al[2] in 2010. A large number of researches have shown that low serum albumin concentration is associated with an increased risk of VTE [3],but there is a lack of studies on serum albumin in VTE, and there are no reports on PPS in rheumatology inpatients.

Objectives:

To investigate the status of VTE in patients in the department of rheumatology, and to explore the value of PPS combined with serum albumin in the identification of VTE in this patient population.

Methods:

Baseline data of inpatients in rheumatology department were collected at Sichuan Provincial People’s Hospital from September 2018 to September 2020. Occurrence of VTE was compared between high and low risk groups. PPSs were analyzed in VTE and non-VTE patients. Multivariate logistic regression was used to analyze the independent risk factors of VTE. The receiver operating characteristic curve was used to evaluate the probablity of value of rheumatic inpatients with VTE assessed by PPS,serum albumin and PPS with serum albumin. P<0.05 indicates that the difference was statistically significant.

Results:

A total of 2282 patients were included in this study, and 50(2.2%) had symptomatic VTE. Among the symptomatic VTE cases,38(1.6%) had DVT only,8(0.4%) had PE only, and 4(0.2%) were diagnosed with DVT and PE. PPSs in VTE and non-VTE groups were 3.00(2.00~6.00) and2.00(1.00~2.00) respectively (P< 0.05). One hundred and eighty-eight cases was divided into high-risk group of VTE (PPS≥4), while 2094 cases (PPS<4) were in the low-risk group. Logistic regression analysis showed that known thrombophilic condition, history of VTE, reduced mobility, and D-dimer were independent risk factors of VTE in rheumatology patients, the odd ration(OR) values were 161.90, 26.08, 8.73,and1.04. Serum albumin was the independent protection factor [OR= 0.92(95%CI:0.87~0.98)]. The AUC of PPS model, serum albumin model and the combined predictive model were 0.77, 0.75, 0.84, respectively. The difference between the combined prediction model and PPS model was statistically significant (Z=3.813, P<0.05). The optimal sensitivity of PPS and serum albumin models is 60%, 82%, respectively, and the optimal specificity of is 82.5%,58.6%, respectively. The combination model corresponds to a sensitivity of 62% and a specificity of 90.4%.

Conclusion:

The incidence of symptomatic VTE was relatively higher in hospitalized patients in rheumatology department. Serum albumin was the protective factor. The combination of albumin and PPS can improve the accuracy of screening for VTE in rheumatology in-patients.

References:

[1]Tamaki H,Khasnis A.Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.[J].Vasc Med, 2015, 20: 369-76.

[2]Barbar S, Noventa F, Rossetto V,et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score[J]. J Thromb Haemost,2010,8(11):2450–2457.

[3]Kunutsor SK,Seidu S,Katechia DT et al. Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein.[J].Ann Med, 2018, 50: 240-248.

Disclosure of Interests:

None declared

Carbon-nanotube-entangled Co,N-codoped carbon nanocomposite for oxygen reduction reaction

The design of highly efficient and stable electrocatalysts for oxygen reduction reaction (ORR) is still a great challenge. Herein, we prepared Co,N-codoped carbon nanocomposites (Co@NC-ZM) with entangled carbon nanotubes. The large Brunauer-Emmett-Teller surface area (604.7 m² g^-1), rich mesoporous feature, Co,N doping and synergetic effect between various species of Co@NC-ZM can expose more active sites and facilitate conductivity and mass transport. Benefiting from the above unique advantages, Co@NC-ZM exhibits excellent ORR performance with more positive onset potential (0.96 V) and half-wave potential (0.83 V) than those of commercial Pt/C (0.96 and 0.81 V, correspondingly). This work provides a new strategy for further exploring efficient non-precious-metal-based catalysts for ORR.

Managing multidrug-resistant tuberculosis in South Africa: a budget impact analysis

SETTING: In South Africa prior to 2016, the standard treatment regimen for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was 24 months long and required daily injectable aminoglycoside (IA) treatment during the first 6 months. Recent evidence supports the replacement of IA with well-tolerated oral bedaquiline (BDQ) and a shortened 9-12 month regimen.DESIGN: Using a Markov model, we analyzed the 5-year budgetary impact and cost per successful treatment outcome of four regimens: 1) IA long-course, 2) oral long-course, 3) IA short-course, and 4) oral short-course. We used the South African MDR/RR-TB case register (2013-2015) to assess treatment outcomes for the then-standard IA long-course. Data on the improvement in outcomes for BDQ-based regimens were based on the literature. Costs were estimated from the provider perspective using costs incurred to provide decentralized treatment for MDR-TB at a Johannesburg hospital.RESULTS: Based on our analysis, by 2023, the cost/successful outcome for the four regimens was respectively 1) US$7374, 2) US$7860, 3) US$5149, and 4) US$4922. The annual total cost of each regimen was US$37 million, US$43 million, US$26 million, and US$28 million.CONCLUSION: Despite the high cost of BDQ, a BDQ-based shortened regimen for the treatment of MDR/RR-TB will result in improved treatment outcomes and cost savings for South Africa.