Impaired local Vitamin D3 metabolism contributes to IL-36g overproduction in epithelial cells in chronic rhinosinusitis with nasal polyps

BACKGROUND

Vitamin D (VD) possesses immunomodulatory properties, but its role in chronic rhinosinusitis with nasal polyps (CRSwNP) remains poorly studied. Herein, we aim to explore the regulation and function of VD3 in CRSwNP.

METHODS

25-hydroxyvitamin D3 (25VD3) levels in serum and tissue lysates were detected by ELISA. The expression of VD receptor (VDR) and cytochrome P450 family 27 subfamily B member 1 (CYP27B1), the enzyme that converts 25VD3 to the active 1,25-hydroxyvitamin D3 (1,25VD3), and their expression regulation in human nasal epithelial cells (HNECs) were studied by RT-PCR, western blotting, immunofluorescence, and flow cytometry. RNA sequencing was performed to identify genes regulated by 1,25VD3 in HNECs. HNECs and polyp tissue explants were treated with 1,25VD3, 25VD3, and dexamethasone.

RESULTS

25VD3 levels in serum and nasal tissue lysates were decreased in patients with eosinophilic and noneosinophilic CRSwNP than control subjects. The expression of VDR and CYP27B1 were reduced in eosinophilic and noneosinophilic CRSwNP, particularly in nasal epithelial cells. VDR and CYP27B1 expression in HNECs were downregulated by interferon y and poly (I:C). Polyp-derived epithelial cells demonstrated an impaired ability to convert 25VD3 to 1,25VD3 than control tissues. 1,25VD3 and 25VD3 suppressed IL-36y production in HNECs and polyp tissues, and the effect of 25VD3 was abolished by siCYP27B1 treatment. Tissue 25VD3 levels negatively correlated with IL-36y expression and neutrophilic inflammation in CRSwNP.

CONCLUSION

Reduced systemic 25VD3 level, local 1,25VD3 generation and VDR expression result in impaired VD3 signaling activation in nasal epithelial cells, thereby exaggerating IL-36y production and neutrophilic inflammation in CRSwNP.

Association of serum lipids and abnormal lipid score with cancer risk: a population-based prospective study

BACKGROUND

Serum lipid levels are associated with cancer risk. However, there still have uncertainties about the single and combined effects of low lipid levels on cancer risk.

METHODS

A prospective cohort study of 33,773 adults in Shanghai between 2016 and 2017 was conducted. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were measured. Cox proportional hazard models were used to assess the association of single and combined lipids with overall, lung, colon, rectal, thyroid gland, stomach, and female breast cancers. The effect of the combination of abnormal lipid score and lifestyle on cancer was also estimated.

RESULTS

A total of 926 incident cancer cases were identified. In the RCS analysis, hazard ratios (HRs) of overall cancer for individuals with TC < 5.18 mmol/L or with LDL-C < 3.40 mmol/L were higher. Low TC was associated with higher colorectal cancer risk (HR [95% CI] = 1.76 [1.09-2.84]) and low HDL-C increased thyroid cancer risk by 90%. Abnormal lipid score was linearly and positively associated with cancer risk, and smokers with high abnormal lipid scores had a higher cancer risk, compared to non-smokers with low abnormal lipid scores (P < 0.05).

CONCLUSIONS

Low TC levels were associated with an increased risk of overall and colorectal cancer. More attention should be paid to participants with high abnormal lipid scores and unhealthy lifestyles who may have a higher risk of developing cancer. Determining the specific and comprehensive lipid combinations that affect tumorigenesis remains a valuable challenge.

Impact of shift work on dementia: a systematic review and dose-response meta-analysis

OBJECTIVES

Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is still lacking. We therefore conducted this meta-analysis to explore the association between shift work and the risk of dementia.

STUDY DESIGN

Systematic review and dose-response meta-analysis.

METHODS

PubMed, Embase, and Web of Science databases were systematically searched. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (95% CIs). Generalized least squares regression was used to estimate dose-response associations, and restricted cubic splines were used to examine possible linear or non-linear associations.

RESULTS

Five articles (10 studies) with 72,999 participants and 23,067 cases were eventually included in the meta-analysis. The summary RRs and 95% CIs of dementia risk with shift work and night shift work versus daytime work were 1.13 (95% CI: 1.05-1.21, I2 = 46.70%) and 1.13 (95% CI: 1.03-1.24, I2 = 9.20%), respectively. The risk of dementia increased by 1% (RR = 1.01, 95% CI: 1.01-1.02, I2 = 41.3%) with each 1-year increase in the duration of shift work. We found a non-linear dose-response association between the duration of shift work and the risk of dementia (Pnon-linearity = 0.006). Though the shape of the curve was steeper with the duration of shift work <7 years, the increase was more gradual after 7 years.

CONCLUSION

Our findings suggest that shift work may be a risk factor for future dementia and that controlling the length of shift work is a feasible measure that may contribute to prevent dementia.

[Epidemiological characteristics of incident cases and risk factors of hepatitis C infection in Beijing City from 2004 to 2021]

Objective: To analyze the epidemiological characteristics and related factors of hepatitis C in Beijing City from 2004 to 2021. Methods: Descriptive epidemiological method and Joinpoint regression were used to analyze the trend and other epidemiological characteristics of hepatitis C in Beijing City from 2004 to 2021 in National Notifiable Disease Reporting System. According to a 1∶1 matched case-control study design, logistic regression was used to investigate the risk factors of hepatitis C infection in 2021. Results: From 2004 to 2021, the reported incidence of hepatitis C in Beijing City ranged from 2.37/100 000 to 10.46/100 000. The reported cases were mainly aged 30-60 years, and most of them were chronic. The reported incidence of hepatitis C showed an initial increase from 2004 to 2006 (APC=45.37%, 95%CI:-1.56%-114.69%), and declined after 2006 (APC=-9.21%, 95%CI:-10.70%-7.70%). Logistic analysis showed that history of surgery (OR=1.84, 95%CI: 1.08-3.14) and previous blood transfusion (OR=34.22, 95%CI: 8.05-145.41) were risk factors for hepatitis C infection. Conclusion: The reported incidence of hepatitis C in Beijing City increases first and decreases later. It currently remains at a low level. The risk factors of infection are surgery and blood transfusion history. Safe blood supply and preventing iatrogenic transmission should be focused on the prevention of hepatitis C transmission.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis

BACKGROUND AND PURPOSE

There is no clear association between plaque distribution and postoperative complications in patients with basilar artery atherosclerotic stenosis. The aim of this study was to determine whether plaque distribution and postoperative complications after endovascular treatment for basilar artery stenosis are related.

MATERIALS AND METHODS

Our study enrolled patients with severe basilar artery stenosis who were scanned with high-resolution MR imaging and followed by DSA before the intervention. According to high-resolution MR imaging, plaques can be classified as ventral, lateral, dorsal, or involved in 2 quadrants. Plaques affecting the proximal, distal, or junctional segments of the basilar artery were classified according to DSA. An experienced independent team assessed ischemic events after the intervention using MR imaging. Further analysis was conducted to determine the relationship between plaque distribution and postoperative complications.

RESULTS

A total of 140 eligible patients were included in the study, with a postoperative complication rate of 11.4%. These patients were an average age of 61.9 (SD, 7.7) years. Dorsal wall plaques accounted for 34.3% of all plaques, and plaques distal to the anterior-inferior cerebellar artery accounted for 60.7%. Postoperative complications of endovascular treatment were associated with plaques located at the lateral wall (OR = 4.00; 95% CI, 1.21-13.23; P = .023), junctional segment (OR = 8.75; 95% CI, 1.16-66.22; P = .036), and plaque burden (OR = 1.03; 95% CI, 1.01-1.06; P = .042).

CONCLUSIONS

Plaques with a large burden located at the junctional segment and lateral wall of the basilar artery may increase the likelihood of postoperative complications following endovascular therapy. A larger sample size is needed for future studies.

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

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

Vitamin D supplementation and adverse skeletal and non-skeletal outcomes in individuals at increased cardiovascular risk: Results from the International Polycap Study (TIPS)-3 randomized controlled trial

BACKGROUND AND AIMS

Vitamin D has mostly been tested in Western populations. We examined the effect of high dose vitamin D in a population drawn predominantly from outside of Western countries.

METHODS AND RESULTS

This randomized trial tested vitamin D 60,000 IU monthly in 5670 participants without vascular disease but at increased CV risk. The primary outcome was fracture. The secondary outcome was the composite of CV death, myocardial infarction stroke, cancer, fracture or fall. Death was a pre-specified outcome. Mean age was 63.9 years, and 3005 (53.0%) were female. 3034 (53.5%) participants resided in South Asia, 1904 (33.6%) in South East Asia, 480 (8.5%) in South America, and 252 (4.4%) in other regions. Mean follow-up was 4.6 years. A fracture occurred in 20 participants (0.2 per 100 person years) assigned to vitamin D, and 19 (0.1 per 100 person years) assigned to placebo (HR 1.06, 95% CI 0.57-1.99, p-value = 0.86). The secondary outcome occurred in 222 participants (1.8 per 100 person years) assigned to vitamin D, and 198 (1.6 per 100 person years) assigned to placebo (HR 1.13, 95% CI 0.93-1.37, p = 0.22). 172 (1.3 per 100 person years) participants assigned to vitamin D died, compared with 135 (1.0 per 100 person years) assigned to placebo (HR 1.29, 95% CI 1.03-1.61, p = 0.03).

CONCLUSION

In a population predominantly from South Asia, South East Asia and South America, high-dose vitamin D did not reduce adverse skeletal or non-skeletal outcomes. Higher mortality was observed in the vitamin D group.

REGISTRATION NUMBER

NCT01646437.

Early Release Science of the exoplanet WASP-39b with JWST NIRSpec PRISM

Transmission spectroscopy1-3 of exoplanets has revealed signatures of water vapour, aerosols and alkali metals in a few dozen exoplanet atmospheres4,5. However, these previous inferences with the Hubble and Spitzer Space Telescopes were hindered by the observations' relatively narrow wavelength range and spectral resolving power, which precluded the unambiguous identification of other chemical species-in particular the primary carbon-bearing molecules6,7. Here we report a broad-wavelength 0.5-5.5 µm atmospheric transmission spectrum of WASP-39b8, a 1,200 K, roughly Saturn-mass, Jupiter-radius exoplanet, measured with the JWST NIRSpec's PRISM mode9 as part of the JWST Transiting Exoplanet Community Early Release Science Team Program10-12. We robustly detect several chemical species at high significance, including Na (19σ), H2O (33σ), CO2 (28σ) and CO (7σ). The non-detection of CH4, combined with a strong CO2 feature, favours atmospheric models with a super-solar atmospheric metallicity. An unanticipated absorption feature at 4 µm is best explained by SO2 (2.7σ), which could be a tracer of atmospheric photochemistry. These observations demonstrate JWST's sensitivity to a rich diversity of exoplanet compositions and chemical processes.

Current diagnosis and potential obstacles for post-neurosurgical bacterial meningitis

Despite the guidance of aseptic technology applied, bacterial meningitis seems to be an unavoidable obstacle in the process of neurosurgery, with high rates of disability and mortality. The diagnosis of post-neurosurgical bacterial meningitis (PNBM) mainly depends both on clinical symptoms and laboratory outcomes. Due to the excessive neuro-inflammatory reactions which are evoked by the primary brain disease or the craniotomy operation, the symptoms derived from the infection and aseptic may not be easily distinguished. On the other hand, the low positive rate and time-consuming character restrict the clinical practical values of bacterial culture. Therefore, it is always difficult to make a definite diagnosis of post-neurosurgical bacterial meningitis. Here, we reviewed the established literature about the diagnostic biomarkers for the PNBM and analyzed the potential obstacles in both clinical and scientific studies. Given the obstacle which has negative impacts on further investigation about the biology of PNBM, we only find relatively small numbers of study on PNBM. In this review, we summarize the established diagnostic methods and biomarkers for PNBM. Meanwhile, we also propose some potential investigation prospects. This review may help to better understand the character of PNBM in both clinical diagnosis and scientific investigations.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

[Overlap esophagojejunostomy with multi-mode modifications in totally laparoscopic total gastrectomy: safety and feasibility of 152 cases from a single center]

Objective: Currently, the Overlap anastomosis is one of the most favored reconstruction methods of intracorporeal esophagojejunostomy (EJS). Despite many advantages of the method, it remains some shortcomings to be improved when it comes to the retraction of the esophagus stump, the insertion of the anvil fork of the linear stapler into a "pseudo" lumen, and the closure of the common entry hole. This study aims to investigate the safety and feasibility of a multi-mode modified Overlap anastomosis. Methods: A descriptive case series study was conducted. Medical records of 152 consecutive patients who underwent totally laparoscopic total gastrectomy (TLTG) with our multi-mode modified Overlap EJS method by the same surgical team at our department from February 2017 to June 2020 were retrospectively analyzed. The multi-mode modified Overlap method mainly included (1) After ensuring the safety of tumor resection margin (proximal margin was at least 3 cm from the tumor), the esophagus was partially transected from left to right (with 5-8 mm width esophagus continuation). The specimen was then placed in a plastic bag which was tied up at the mouth using strings with a part of the esophageal wall poking through. Then the plastic bag containing the specimen was transferred to the right lumbar region, while the patient's body position was adjusted so that the abdominal esophagus could be pulled by the gravity of the specimen. (2) Using the "three-direction traction" method. The esophageal lumen was properly exposed, then guided by the gastric tube, the anvil fork was accurately placed into the esophageal lumen for completing the side-to-side EJS. (3) The 3-0 barbed suture was used in the closure of the common entry hole of the stapler from dorsally to ventrally with simple one-layer continuous suture (the stitch going from inside to inside) followed by continuous Lembert's suture (the stitch going from outside to outside). Combined with clinicopathological characteristics, the perioperative outcomes and postoperative complications of the whole group were analyzed and evaluated. Results: The study cohort included 129 men and 23 women, with a mean age of (60.2±9.1) years and a mean body mass index (BMI) of (23.2±3.1) kg/m(2). Of the 152 patients, 23 patients (15.1%) had a history of previous abdominal surgery; dentate line was invaded by tumor in 21 patients (13.8%). The mean length of the proximal resection margin was (3.3±0.3) cm and the postoperative pathological examination indicated negative resection margin tumor. The mean operative time and anastomotic time were (302.1±39.9) minutes and (29.8±5.4) minutes, respectively. The mean estimated blood loss was (87.9±46.4) ml. The mean length of postoperative hospital stay was (12.3±7.3) days. The overall severe postoperative complications (Clavien-Dindo ≥ II) occurred in 22 patients (14.5%). Six cases of pancreatic leakage were successfully recovered by adequate drainage, inhibition of pancreatic exocrine secretion and nutritional support. Ten cases of pneumonia and three cases of abdominal infection were cured with anti-infection and physical therapy. Two patients developed anastomotic leakage postoperatively. One case was caused by excessive tension of the Roux loop of the jejunum and excessive opening on the side of the jejunum after side-to-side anastomosis, and the other case was caused by an accidental intraoperative occurrence of "nasogastric tube stapled to the side-to-side anastomosis". Both of them recovered after conservative treatment including adequate drainage, anti-infection, and adequate nutritional support. One patient underwent immediate open surgery because of Peterson's hernia 7 days after TLTG, and the patient died due to extensive small bowel necrosis. Conclusions: Multi-mode modified overlap method simplifies the operation and reduces the difficulty of EJS. It is a safe and feasible method for EJS.

[Technical details of gastrointestinal reconstruction using linear stapler in totally laparoscopic total gastrectomy]

With the development of instrument, equipment and surgical skills, especially the emergence of a series of high-level medical evidence, the laparoscopic techniques in the field of gastric surgery has been further expanded. Totally laparoscopic total gastrectomy (TLTG) has certain technical difficulties, and more challenges are reflected in the digestive tract reconstruction. The use of linear staplers has reduced the difficulty of digestive tract reconstruction to a certain extent and has strongly promoted the transition from laparoscopic-assisted total gastrectomy to TLTG. However, for TLTG, there are still many details that should be carefully concerned, so as to effectively avoid the surgical pitfalls and ensure the fluency and safety of the procedure. In this article, we discuss the surgical details based on our own experiences, including how to obtain surgical field exposure well, how to manage specific accidents when using linear stapler for esophagojejunostomy, how to prevent intra-abdominal hernias and Roux stasis syndrome, and how to prevent the stapled lines of the esophageal or jejunal stumps from direct contact with aorta.

Leptin Aggravates Periodontitis by Promoting M1 Polarization via NLRP3

Periodontitis is characterized by periodontal pocket formation, loss of attachment, and alveolar bone resorption. Both innate and adaptive immunity are involved in the pathogenesis of this oral chronic inflammatory disease. Accumulating evidence indicates a critical role of leptin in periodontal diseases. However, the mechanism by which leptin promotes periodontitis pathogenesis remains unclear. In the present study, we observed an elevated expression of leptin in the serum of periodontitis mice compared to that in healthy controls. There was a higher extent of M1 phenotype macrophage infiltration in mice periodontitis samples than in healthy controls. A positive correlation was observed between the serum leptin levels and M1 macrophages. Treatment with leptin increased M1 macrophage polarization and decreased M2 macrophage polarization in RAW 264.7 cells. Moreover, leptin facilitated lipopolysaccharide (LPS)-induced M1 phenotype macrophage polarization in RAW 264.7 cells. In bone marrow-derived macrophages (BMDMs) generated from leptin-deficient obese (ob/ob) mice, M1 macrophage polarization was significantly attenuated after LPS stimulation compared to the healthy controls. With regards to the molecular mechanism, we found that leptin activated the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome and promoted M1 polarization via the NLRP3 inflammasome in vitro. In BMDMs generated from Nlrp3^-/- mice, M1 macrophage polarization was significantly attenuated after synchronous stimulation with leptin and LPS compared with BMDMs produced by healthy controls. The NLRP3 inhibitor MCC950 also prevented leptin-mediated M1 macrophage polarization in RAW 264.7 cells. Nlrp3^-/- periodontitis models indicated that leptin aggravates the periodontal response to the ligature by promoting M1 macrophage polarization via the NLRP3 inflammasome. Taken together, we show that leptin promotes the progression of periodontitis via proinflammatory M1 macrophage skewing, and targeting leptin/NLRP3 signaling may be a feasible approach for treating periodontitis.

ELK1-induced up-regulation of KIF26B promotes cell cycle progression in breast cancer

KIF26B is a member of the kinesin superfamily that is up-regulated in various tumors, including breast cancer (BC), which can promote tumor progression. This study aimed to investigate the potential function of KIF26B in BC, and the underlying mechanisms, focusing mainly on cell proliferation. KIF26B expression was examined in BC tissue samples obtained from 99 patients. Then, we performed MTS, EdU and flow cytometry assays to detect cell proliferation, and western blotting to measure the expression of cell cycle-related proteins in MDA-MB-231 and MDA-MB-468 cells following KIF26B knockdown. Promoter analysis was used to study the upstream regulatory mechanism of KIF26B. KIF26B was upregulated in BC tissues. High expression of KIF26B was associated with clinicopathological parameters, such as positive lymph node metastasis, higher tumor grade, and higher proliferative index in BC. Furthermore, knockdown of KIF26B expression inhibited MDA-MB-231 and MDA-MB-468 cell proliferation, arresting cells in the G₁ phase of the cell cycle in vitro. Similarly, KIF26B silencing decreased the expression levels of Wnt, β-catenin, and cell cycle-related proteins such as c-Myc, cyclin D1, and cyclin-dependent kinase 4, while increasing the expression of p27. Moreover, ELK1 could bind to the core promoter region of KIF26B and activate its transcription. KIF26B acts as an oncogene in BC by regulating multiple proteins involved in the cell cycle. ELK1 activates KIF26B transcription.

MiR-587 acts as an oncogene in non-small-cell lung carcinoma via reducing CYLD expression

OBJECTIVE

This study aims to explore the cancer-associated functions of microRNA-587 (miR-587) in the development of non-small-cell lung carcinoma (NSCLC) and the molecular mechanism.

PATIENTS AND METHODS

Relative expression levels of miR-587 and CYLD in NSCLC samples were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Proliferative and migratory abilities in A549 and H1299 cells with overexpressed miR-587 were examined by Cell Counting Kit-8 (CCK-8) and transwell assay, respectively. The regulatory interaction between miR-587 and CYLD was determined by Dual-Luciferase reporter assay and Pearson correlation test. At last, the co-regulation of miR-587 and CYLD on NSCLC cell functions was assessed by rescue experiments.

RESULTS

MiR-587 was upregulated in NSCLC samples and closely linked to tumor staging, whereas CYLD was downregulated and negatively correlated to that of miR-587. Survival analysis suggested that miR-587 was an unfavorable factor to the prognosis of NSCLC. Overexpression of miR-587 stimulated proliferative and migratory abilities in A549 and H1299 cells. CYLD was the downstream gene binding miR-587. Overexpression of CYLD could partially abolish the regulatory effects of overexpressed miR-587 on promoting proliferative and migratory abilities in NSCLC cells.

CONCLUSIONS

MiR-587 stimulates proliferative and migratory abilities in NSCLC by downregulating CYLD, thus aggravating the progression of NSCLC.

Province-specific recalibration of CVD risk models using population-specific routine data for Chinese people is important

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular diseases (CVD) are the leading causes of death in China. Since population CVD incidence and risk factor levels vary considerably across regions in China, geo-specific investment in the prevention of CVD could be advantageous. Risk prediction models are an integral part of CVD prevention guidelines and can be used to help guide intervention. However, there is no CVD model generalizable to the various incidence rates, risk-factor levels and composition of CVD in different regions of China.

Purpose

To construct a CVD risk estimation system, which is calibrated to CVD risk in different regions in China, and can be regularly updated in the future using routinely available aggregate level CVD incidence and risk factor data, in response to changing trends with time and divergent CVD rates.

Methods

The risk prediction model used was the WHO CVD score, initially calibrated to predict CVD mortality in the whole of mainland China. Further province-specific recalibration was then completed to give models tailored to the 31 provinces. The recalibration approach used aggregate level province, sex- and age group-specific levels of risk factors and CVD mortality. Risk factor values were estimated using 145 268 participants aged 40-80 years old from the China Chronic Disease and Risk Factors Surveillance, a nationally and provincially representative cross-sectional survey in 2015. Province-specific CVD mortality rates in 2017 were estimated based on published scientific reports, unpublished registry data, and health system administrative data.

Results

Compared with the province-specific models, the China-specific WHO score overestimated mortality risk in some provinces while underestimating risk in others. For example, while the predicted population risk of 10-year CVD mortality was 3.5% in male in both Shanghai and Hebei using the China-specific score (with province-specific observed risk factor values), the province-specific scores gave predicted population risks of 1.1% for Shanghai and 5.5% for Hebei. Accordingly, using the province-specific scores for an individual with the same combination of risk factors, the 10-year risk of CVD mortality differed substantially across provinces. For example, the estimated 10-year risk for a 60 year old, male smoker without diabetes and systolic blood pressure of 140 mmHg and total cholesterol 5 mmol/L ranged from 2.4% in Shanghai to 13.2% in Tibet. Similarly, the estimated 10-year risk for a female with the same risk factor profile ranged from 1.5% in Shanghai to 11.5% in Tibet.

Conclusion

We have developed a CVD risk estimation system, which is calibrated to CVD risk in different provinces of China, and can be regularly recalibrated in the future using routinely available information. Application of this approach should help accurately estimate CVD risk in individuals from China, and assist policy makers in making more appropriate decisions about allocation of preventative resources.

Abstract Figure. Predicted 10 year CVD mortality risk

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

Cost-effectiveness analysis of screening in epidemiology is essential for public health decision-making. This paper describes the general principles, basic steps involved in implementation, analytic methods and other related issues of Markov model. Based on a practical research case of evaluating the cost-effectiveness of primary open-angle glaucoma screening in a Chinese population, key points in applications of Markov model for cost-effectiveness analysis of screening were discussed in detail, including model development, parameters definition, available software, base case analysis, sensitivity analysis and the interpretation of the results. For better supporting evidence-informed decision making in public health, future studies should be aware of the accuracy of parameters in Markov models and the transparency of the models and results, as well as complying with the relevant reporting standards.

High expression of LINC0163 promotes progression of papillary thyroid cancer by regulating epithelial-mesenchymal transition MITF

OBJECTIVE

The purpose of this study was to detect the expression of long non-coding ribonucleic acid 00163 (LINC00163) in human papillary thyroid cancer (PTC), and to observe the influence of downregulated LINC00163 on the proliferative and metastatic capacities of human PTC cells.

PATIENTS AND METHODS

Quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) assay was applied to measure the expression level of LINC00163 in PTC tissues and para-carcinoma tissues, as well as that in normal human thyroid cells (Nthy-ori3-1) and PTC cells. After the expression of LINC00163 in PTC cells was interfered, qRT-PCR assay was performed to determine the interference efficiency, and colony formation and Cell Counting Kit-8 (CCK-8) assays were conducted to study the impacts of small interfering (si)-LINC00163 on the proliferative capacity of PTC cells. Moreover, wound healing and transwell assays were adopted to investigate the changes in the migratory and invasive abilities of PTC cells after the interference in the expression of LINC00163 in PTC cells. Finally, the changes in expressions of molecular markers in downstream signaling pathways after interference in LINC00163 expression were examined via Western blotting assay.

RESULTS

In 51 cases of PTC tissues and corresponding para-carcinoma tissues, 41 cases exhibited an up-regulated expression of LINC00163, and qRT-PCR results indicated that PTC cells also had an up-regulated expression of LINC00163 compared with normal human thyroid cells. After the expression of LINC00163 in PTC cells was interfered, the results of colony formation and CCK-8 assays manifested that the proliferative capacity of the cells declined. It was also shown in wound-healing and transwell assay results that the migratory and invasive abilities of the cells were weakened. In addition, the results of Western blotting assay revealed expression changes in the molecular markers of epithelial-mesenchymal transition (EMT).

CONCLUSIONS

The expression of LINC00163 in NSCLC tissues and cells is upregulated, and highly expressed LINC00163 can promote PTC cell proliferation and metastasis by regulating the EMT.

A triple-classification radiomics model for the differentiation of pleomorphic adenoma, Warthin tumour, and malignant salivary gland tumours on the basis of diffusion-weighted imaging

AIM

To develop and validate a triple-classification radiomics model for the preoperative differentiation of pleomorphic adenoma (PA), Warthin tumour (WT), and malignant salivary gland tumour (MSGT) based on diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

Data from 217 patients with histopathologically confirmed salivary gland tumours (100 PAs, 68 WTs, and 49 MSGTs) from January 2015 to March 2019 were analysed retrospectively and divided into a training set (n=173), and a validation set (n=44). A total of 396 radiomic features were extracted from the DWI of all patients. Analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO) regression were used to select radiomic features, which were then constructed using three classification models, namely, logistic regression method (LR), support vector machine (SVM), and K-nearest neighbor (KNN). The diagnostic performance of the radiomics model was quantified by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) of the training and validation data sets.

RESULTS

The 20 most valuable features were investigated based on the LASSO regression. LR and SVM methods exhibited better diagnostic ability than KNN for multiclass classification. LR and SVM had the best performance and yielded the AUC values of 0.857 and 0.824, respectively, in the training data set and the AUC values of 0.932 and 0.912, respectively, in the validation data set of MSGT diagnosis.

CONCLUSION

DWI-based triple-classification radiomics model has predictive value in distinguishing PA, WT, and MSGT, which can be used for preoperative auxiliary diagnosis in clinical practice.

MiR-203 regulates DJ-1 expression and affects proliferation, apoptosis and DDP resistance of pancreatic cancer cells

OBJECTIVE

DJ-1 is a negative regulator of PTEN and plays a role in tumorigenesis. Abnormal miR-203 expression is associated with pancreatic cancer. Bioinformatics analysis showed a targeted relationship between miR-203 and DJ-1 3'-UTR. This study investigated whether miR-203 regulates DJ-1 expression and its role in pancreatic cancer cell proliferation, apoptosis, and cisplatin (DDP) resistance.

MATERIALS AND METHODS

The Dual-Luciferase reporter gene assay validated the targeted regulation between miR-203 and DJ-1. The DDP-resistant cell line SW1990/DDP was established and divided into miR-NC group and miR-203 mimic group followed by analysis of the expression of DJ-1, PTEN and p-AKT, cell apoptosis, and proliferation.

RESULTS

There was a targeted relationship between miR-203 and DJ-1 mRNA. The expression of miR-203 in SW1990/DDP cells was significantly lower than that in SW1990 cells, while the expression of DJ-1 mRNA and protein was significantly higher than that in SW1990 cells. Compared with miR-NC group, the expression of DJ-1 and p-AKT protein in SW1990/DDP cells was significantly decreased in miR-203 mimic transfection group, while the expression of PTEN was significantly increased with increased cell apoptosis and decreased cell proliferation, as well as reduced DDP resistance.

CONCLUSIONS

The decreased expression of miR-203 and the increased expression of DJ-1 is associated with drug resistance in pancreatic cancer cells. Elevated miR-203 can inhibit the expression of DJ-1, affect the activity of PTEN-PI3K/AKT pathway, inhibit the proliferation of pancreatic cancer cells, induce cell apoptosis, and reduce DDP resistance of pancreatic cancer cells.

[The predictive value of serum alkaline phosphatase combined with parathyroid hormone in all-cause and cardiovascular mortality in maintenance hemodialysis patients]

To analyze the predictive value of serum intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) on all-cause and cardiovascular mortality in maintaining hemodialysis (MHD) patients. A total of 224 MHD patients were prospectively investigated and followed up for 2 years. Serum iPTH levels were not associated with all-cause death and cardiovascular death (HR=1.001, 95%CI 1.000-1.004, P=0.048) . The level of serum ALP was associated with cardiovascular death (HR=1.002, 95%CI 1.000-1.004, P=0.033) . ALP≥106 IU/L was an independent risk factor for cardiovascular death in MHD patients (P<0.05) . The joint variable was correlated with mortality in MHD patients (HR=1.002, 95%CI 1.000~1.004, P=0.033) , that equal or over 37.28 was an independent risk factor for mortality (P<0.05).

[Application of the China-PAR stroke risk equations in a rural northern Chinese population]

OBJECTIVE

To validate five-year risk prediction models for stroke in a contemporary rural Northern Chinese population.

METHODS

Totally 6 483 rural adults aged 40 to 79 years without cardiovascular diseases were enrolled at baseline between June and August 2010, and followed up through January 2017. Expected prediction risk using the China-PAR (prediction for atherosclerotic cardiovascular disease risk in China) stroke risk equations were compared with the new Framingham stroke risk profile (FSRP). The recalibrated models were applied by adjusting the five-year baseline survival rate and the mean score to our rural northern Chinese population, while keeping other coefficient parameters the same as the original models. Kaplan-Meier analysis was used to obtain the observed event (nonfatal or fatal stroke) rate for the five years, and the expected-observed ratios were calculated to evaluate overestimation or underestimation in the cohort. The models were assessed by discrimination C statistic, calibration χ², and calibration charts and plots for illustration as well.

RESULTS

Over an average of (5.83 ± 1.14) years of the follow-up in this validation cohort with 6 483 rural Chinese participants, 438 subjects deve-loped a first stroke event. Recalibrated China-PAR stroke risk equations and FSRP well-performed for predicting five-year stroke risk in men, and had C statistics of 0.709 (95%CI, 0.675 - 0.743) and 0.721 (95%CI, 0.688 - 0.754), with calibration χ² values being 5.7 (P = 0.770) and 13.6 (P = 0.137), respectively. However, both China-PAR and FSRP overestimated stroke events by 11.6% and 30.0% in women, and had C statistics of 0.713 (95%CI, 0.684-0.743) and 0.710 (95%CI, 0.679-0.740), respectively. Calibration χ² values in women were 12.5 (P = 0.188) for China-PAR and 24.0 (P = 0.004) for FSRP. In addition, the calibration charts and plots illustrated good agreement between the observations and the predictions only in the China-PAR stroke risk equations, especially for men.

CONCLUSION

In this validation cohort of rural northern Chinese adults, the China-PAR models had better performance of five-year stroke risk prediction than the FSRP, indicating that recalibrated China-PAR stroke risk equations might be appropriate tools for risk assessment and primary prevention of stroke in China.

[Needs of pre-exposure prophylaxis for HIV infection and related barriers among men who have sex with men]

Objective: To understand the actual needs for the pre-exposure prophylaxis (PrEP) for HIV infection and the factors hindering PrEP utilization in men who have sex with men (MSM). Methods: Participants were recruited by using MSM social application software Blued 6.5.0 and through MSM peer referral, sample size was 600. An electronic questionnaire survey was conducted anonymously with guidance of investigators via "Questionnaire Star" platform. The contents of the survey included demographic characteristics of the participants, the awareness of PrEP related knowledge, willingness and concerns about using PrEP, actual need for PrEP and self-efficacy of using PrEP. Results: A total of 622 MSM completed the survey, of whom 56.4% (351/622) and 4.3% (27/622) ever heard of and received PrEP, respectively. The need assessment of PrEP showed that 67.2% (418/622) of the participants had actual needs for PrEP and 21.2% (132/622) used PrEP with good self-efficacy. Structural equation modeling analysis showed that the awareness of PrEP related knowledge and concerning about PrEP utilization in MSM played a direct positive role in their self-efficiency of using PrEP, and the effect coefficients were 0.08 and 0.13, respectively. MSM self-discrimination indirectly affected the self-efficiency of using PrEP through concerns about PrEP use, the effect coefficient was 0.035. The result of generalized linear mixed model analysis demonstrated that the utilization of PrEP can improve the self-efficacy of using PrEP (OR=5.55), which increased by 0.14 times and 0.07 times with the increase of 1 score of the awareness of PrEP related knowledge and concern about using PrEP respectively. In addition, this survey found that in the participants, the main concerns about using PrEP were side effects, HIV prevention effect and its expense, accounting for 61.1% (380/622), 60.1% (374/622) and 53.2% (331/622), respectively. Most participants hoped to obtain PrEP services from CDC, MSM social organization and internet, accounting for 75.6% (470/622), 65.4% (407/622), and 63.8% (397/622), respectively. Conclusions: MSM showed difference of high need but low utilization of PrEP services. Low awareness of PrEP related knowledge, concerns about the prevention effect, side effects and expense of PrEP as well as self-discrimination were the factors hindering the use of PrEP in MSM. It is necessary to establish a suitable PrEP service model to meet the needs for PrEP in MSM.

Historical droughts recorded in extended Juniperus procera ring-width chronologies from the Ethiopian Highlands

In the Horn of Africa, little is known about temporal changes in hydroclimate owing to the influence of multiple weather systems, the complex terrain, and the sparse instrumental records. Absolutely dated tree-ring records offer the potential to extend our understanding of climate into the pre-instrumental era, but tree-ring studies in this region, and indeed all of tropical Africa, have been rare largely due to lack of an annual climate cycle that reliably produces annual tree-rings. In this study, 40 cores were obtained from 31 Juniperus procera trees growing in the grounds of Ethiopian Orthodox Tewahedo churches in the Gonder region of Ethiopia. The samples were cross-dated using a re-iterative process involving identifying anatomical features from high-resolution images. The tentative ring-width chronologies were revised after the determination of bomb-peak accelerator mass spectrometry radiocarbon dates. Individual series were significantly correlated to the respective master chronologies (r > 0.55; P < 0.05), and expressed population signal values ranged from 0.55 to 0.92. Historical drought years were successfully traced in the chronologies by pointer year analysis. This study confirms that Juniperus procera growing in areas of unimodal precipitation exhibits annual tree-rings and offers the potential as an indirect measure of past climate.

[Comparison of keratometric measurements obtained by the Verion image guided system with the IOLMaster and the Pentacam before cataract extraction surgery]

Objective: To compare the keratometric measurements of the Verion image guided system with the partial coherence interferometry (IOLMaster700) and the scheimpflug corneal topography (Pentacam). Methods: In this cross-sectional study, 146 eyes of 88 patients [mean age, (69±10) years; 62 eyes of male patients and 84 eyes of female patients] with cataract were examined before cataract extraction and IOL implantation surgery in the Tenth People's Hospital Affiliated to Tongji University from January 2016 to March 2017. Corneal curvature values acquired by the Verion optical imaging system were compared with the IOLMaster700 and the Pentacam. Keratometric data, magnitude of astigmatism, and steep astigmatic axis measurements from all three instruments were also compared. According to the steep axis of astigmatism, the eyes were divided into groups of with the rule (WTR), against the rule (ATR), and oblique astigmatism. The parameter differences between the Verion and the other devices in the three groups were analyzed. The data were evaluated using repeated measures analysis of variance and Bland-Altman plots. Results: The values of steep keratometry (Ks) of the Verion, IOLMaster700, and Pentacam were (44.60±1.32), (44.73±1.37), (44.43±1.35) D, respectively. The values of flat keratometry (Kf) of the Verion, IOLMaster700, and Pentacam were (43.51±1.41), (43.51±1.52), (43.40±1.45) D, respectively. The values of mean keratometry (Km) of the Verion, IOLMaster700, and Pentacam were (44.60±1.32), (44.12±1.35), (43.92±1.34) D, respectively. The values of astigmatism magnitude were (1.09±0.87), (1.24±1.02), (1.04±0.80) D, respectively. The F values were 1.81, 0.31, 0.93 and 2.22 in relation to Ks, Kf, Km and corneal astigmatism magnitude among the three instruments, respectively (all P>0.05). The 95% confidence intervals of Kf, Ks and astigmatism magnitude between the Verion and the other two devices were -1.10 to 0.80 D, -0.55 to 0.88 D; -1.10 D to 1.10 D, -0.80 to 1.04 D; -1.21 to 0.90 D, -0.92 to 1.02 D. The outcomes were considered acceptable. There were no statistically differences in steep astigmatic axis measurements between the Verion and the other two instruments among the WTR (62 eyes), ATR (45 eyes) and oblique (15 eyes) groups (F=0.63, 0.37; P=0.54, 0.72, respectively). Conclusions: The Verion image guided system is a reliable system for the measurement of keratometry values and astigmatism. The keratometric power, magnitude and steep axis of astigmatism have no significant difference, and there is a good agreement among the Verion, IOL Master 700, and Pentacam. (Chin J Ophthalmol, 2020, 56: 47-52).

[The predictive value of epicardial adipose tissue and inflammatory factors for in-stent restenosis]

Objective: To investigate the predictive value of epicardial adipose tissue volume (EATV) and inflammatory factors on in-stent restenosis (ISR) after percutaneous coronary implantation (PCI) in patients with coronary heart disease (CAD). Methods: A total of 407 patients with CAD who were treated with drug-eluting stents in TEDA international cardiovascular disease hospital were enrolled from November 2016 to October 2017. Levels of inflammatory cytokines such as high sensitive c-reactive protein (Hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α) were detected. EATV was measured preoperatively by multi-sliced CT. Patients were divided into ISR group (n=52) and N-ISR group (n=355) according to ISR occurred within 1 year after procedure. The relationship between EATV and inflammatory factors and ISR after PCI was analyzed. Results: The differences between ISR group (n=52) and N-ISR group (n=355) were statistically significant in terms of diabetes history, IL-6, TNF-α, EATV ((150±36) cm(3)vs(120±40) cm(3),P=0.001)), bifurcation lesions, stent length and Gensini score (P<0.05). Multivariate Logistic regression analysis results showed that diabetes history,bifurcation lesions, TNF-α, EATV, and Gensini score were risk factors for in-stent restenosis.The area under the ROC curve (AUC) of EATV, TNF-α, and IL-6 in patients with CAD after PCI was 0.712, 0.752 and 0.675 (95%CI 0.648-0.776, 0.686-0.819, 0.584-0.766, respectively, all P<0.001), with a sensitivity of 86.5%, 67.3% and 69.2%, a specificity of 53.8%, 74.4% and 70.1% and a cut-off value of 116.61 cm(3),138.40 µg/L and 126.4 µg/L, respectively. Conclusion: EATV, TNF-α, and IL-6 have certain predictive values for in-stent restenosis, and can be used as clinical indicators to predict in-stent restenosis.

2387Recurrent cardiovascular events and mortality in relation to antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease (MINOCA)

Background

Approximately 10% of patients presenting with myocardial infarction (MI) do not have obstructive coronary artery disease (MINOCA). The role of antiplatelet therapy and outcomes in this group remain unclear. We assessed prognosis and the effect of an intensified clopidogrel regimen in MINOCA patients.

Methods

We analyzed data from the CURRENT-OASIS 7 trial, which randomized 25,086 patients with acute coronary syndromes (ACS) referred for early intervention to receive either double-dose (600mg day 1; 150mg days 2–7; then 75mg daily) or standard-dose (300mg day 1; then 75mg daily) clopidogrel. We evaluated clinical outcomes at 30-days in patients with versus without obstructive CAD and in relation to standard versus double-dose clopidogrel.

Results

Overall, 23,783 MI patients were included, of which 1,599 (6.7%) had MINOCA. MINOCA patients were younger, more frequently presented with non-ST-segment elevation MI and had fewer comorbidities. Rates of all-cause mortality (0.7% versus 2.4%, p=0.0046), cardiovascular mortality (0.6 versus 2.2%, p=0.0056), repeat MI (0.5% versus 2.3%, p=0.0009) and major bleedings (0.7% versus 2.5%, p=0.0001) were significantly lower among patients with MINOCA versus those with obstructive CAD. Compared with the standard-dose clopidogrel regimen, the double-dose regimen appeared to increase the risk of cardiovascular death, MI or stroke in MINOCA patients (0.8% versus 2.1%, hazard ratio (HR) 2.74, P=0.033). There was no difference in those with obstructive CAD (4.7% versus 4.4%, HR 0.93, P=0.226; P-for-interaction=0.023) (see Figure 1A). Major bleeding did not occur more frequently in MINOCA patients with double- versus standard-dose clopidogrel regimen (0.7% versus 0.6%, (HR 1.16 (95% CI 0.35–3.80), p=0.805), but their rate was higher In MI patients with obstructive CAD (2.7% versus 2.2% (HR 1.26 (95% CI 1.06–1.49), p=0.008) (Figure 1B).

Figure 1A & B

Conclusions

Compared to MI patients with obstructive CAD, patients presenting with MINOCA represent a distinct cohort, which is generally younger, has a higher NSTEMI prevalence and fewer comorbidities. Their risk for adverse events, especially repeat MI, stroke, death, and bleeding, is low (<1%) at 30 days. Applying an intensified clopidogrel regimen in MINOCA patients appears to be related to a higher risk for CV death, MI and stroke. Accordingly, more potent antiplatelet regimens might be harmful among MINOCA patients and should not be administered routinely. Nevertheless, there is a need for more prospective studies evaluating the role of dual antiplatelet therapies in MINOCA patients.

Acknowledgement/Funding

The CURRENT-OASIS 7 trial was sponsored by Sanofi-Aventis and Bristol-Myers Squibb.

P825Long-term clinical benefit of atorvastatin pretreatment before primary percutaneous coronary intervention in patients with STEMI: a multi-center propensity score-matched study

Aims

We aim to investigate the effect of single dose of statin pretreatment prior to primary Percutaneous Coronary Intervention (PCI) on long-term clinical outcomes in patients with ST-elevation Myocardial Infarction (STEMI).

Methods

Using data from China Acute myocardial Infarction (CAMI) registry, we compared the outcome in STEMI patients with vs without atorvastation pretreatment prior to primary PCI. The primary endpoint was the composite outcome of all-cause mortality, non-fatal MI or stroke events during follow-up. Propensity-score (PS) matching was used to assemble a cohort of patients with similar baseline characteristics. All patients were followed till 24 months since baseline.

Results

Of all 3772 patients who met our inclusion criteria at 108 hospitals in China, 3288 patients (1644 patients in each arm) were included in our PS-matched cohort. In the PS-match cohort, overall 144 (8.65%) and 113 (6.79%) patients in the control group and pretreatment group had the primary endpoint respectively (p=0.048). The estimated HRs were 0.78 (95% CI: 0.606–0.997, p=0.046) in the unadjusted model and 0.76 (95% CI: 0.596–0.984, p=0.032) in the adjusted model (Figure). The HRs were broadly similar for the pretreatment dosage of 40 mg or 80 mg (0.78 vs 0.77, p=0.75). The HRs were even stronger in patients with single-vessel only than multi-vessel coronary artery disease (0.31 vs 0.75, p=0.014).

Conclusion

Among Chinese patients with STEMI, atorvastatin pretreatment before primary PCI may have better long-term composite outcome of all-cause mortality, non-fatal MI, or stroke events.

Acknowledgement/Funding

CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

P3623Integrating depression and acute coronary syndrome care in low-resource hospitals in china: primary results from the I-Care randomised clinical trial

Background

Depression and acute coronary syndromes (ACS) are significant public health challenges. Patients with ACS often experience depression, which adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed.

Purpose

I-CARE study is a multi-center, randomised clinical trial (RCT) to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in the management of ACS patients.

Methods

The I-CARE RCT was conducted between October 2014 and March 2018 in 16 rural Chinese hospitals. A total of 4041 patients with ACS were consecutively enrolled and randomly assigned in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem solving therapy and antidepressant medications as needed, or UC. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) scores from baseline to 6 and 12 months. Secondary outcomes included incidence of major adverse events (MAEs) after discharge, quality of life (EQ5D), and adherence to ACS secondary prevention medications. Data analysis used a multilevel mixed-effects model with hospital-level and subject-level random-effect intercepts and hospital-level random slope incorporated to adjust for clustering effect. Primary analyses followed the intent-to-treat principle.

Results

The mean age of the patients was 61±10 years and 63% were men; however, only 3.3% were classified as depressed based upon a cutoff of ≥10 on the PHQ-9, and 26.9% had PHQ-9 scores between 5 to 9 at the baseline. There were no significant differences in patients' clinical characteristics between IC and UC groups. Changes in PHQ-9 scores from baseline to 6- and 12-months did not differ between treatment groups (−1.47 in IC group vs −1.40 in UC group; adjusted mean difference, −0.04; 95% CI, −0.17 to 0.08 at 6-months; −1.62 in IC group vs −1.54 in UC group; adjusted mean difference, −0.06; 95% CI: −0.19 to 0.06 at 12-months).The risk of MAEs after discharge between IC and UC groups also did not differ significantly (42.1% vs 43.1%; p=0.307).

Conclusions

Results from the I-CARE trial showed that a nurse-coordinated ACS and depression IC intervention did not reduce depression or improve clinical outcomes among patients with ACS compared to usual care controls. The low prevalence of depression was unexpected and may have minimized the potential added benefits of the IC intervention on depression and clinical outcomes compared to UC.

Acknowledgement/Funding

This study is supported by a grant from the National Institute of Mental Health (R01MH100332).

Carvedilol alleviates the biliary cirrhosis through inhibiting the endoplasmic reticulum stress

OBJECTIVE

To investigate the effects of carvedilol on inflammation, apoptosis, and hepatic fibrosis caused by biliary cirrhosis and its mechanisms in mice.

MATERIALS AND METHODS

60 male C57/BL6 mice were randomly divided into sham-operation group (Sham group, n=20), biliary cirrhosis group (BDL group, n=20) and carvedilol group (CAR group, n=20). The CAR group was treated with gavage using 12.5 mg/kg carvedilol, once a day for 14 consecutive days, while the Sham group and BDL group were treated with gavage using the equivalent normal saline. After that, the mice in Sham group received the laparotomy under chloral hydrate anesthesia, followed by direct abdominal closure. The mice in BDL group and CAR group received the common bile duct ligation after anesthesia for modeling. After modeling, the survival rate of mice in each group was detected, and the blood and liver tissues were taken for detection. The morphological changes in liver tissues and apoptosis in mice in each group were detected and compared. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), superoxide dismutase (SOD), malondialdehyde (MDA), hydroxyproline, and α-smooth muscle actin (α-SMA) were also detected. The mRNA expression levels of pro-inflammatory factors, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), transforming growth factor β-1 (TGF-β1), α-SMA and collagen-1 were detected via reverse transcription-polymerase chain reaction (RT-PCR). The protein expression levels of CHOP (CCAAT-enhancer-binding protein homologous protein), activating transcription factor 4 (ATF4), ATF6, inositol-requiring enzyme 1 (IRE1), phosphorylated Jun N-terminal kinase (pJNK), α-SMA, and collagen-1, were detected via Western-blotting.

RESULTS

Our study showed that carvedilol could significantly alleviate the biliary cirrhosis in mice, and improve the survival rate of mice. The ALT, AST and TBIL levels, severity of cirrhosis, and number of apoptotic cells in CAR group were significantly lower than those in BDL group. The levels of α-SMA and hydroxyproline in CAR group were also significantly lower than those in BDL group. The activity of SOD in CAR group was significantly higher than that in BDL group; the above differences were statistically significant (p<0.05). In addition, it was also found that carvedilol could down-regulate the mRNA expression levels of iNOS, COX-2 and TGF-β1, down-regulate the mRNA and protein expression levels of α-SMA and collagen-1, and negatively regulate the ATF4-CHOP, ATF6-CHOP and IRE1-pJNK signaling pathways.

CONCLUSIONS

Carvedilol has a significant effect on alleviating the biliary cirrhosis in mice, and its relevant mechanism may be that carvedilol inhibits the endoplasmic reticulum stress through the negative regulation of ATF4-CHOP, ATF6-CHOP and IRE1-pJNK signaling pathways, which needs to be confirmed by further in vitro experiments.

Ral GTPase Activation by Downregulation of RalGAP Enhances Oral Squamous Cell Carcinoma Progression

Ral small GTPases, consisting of RalA and RalB, are members of the Ras family. Their activity is upregulated by RalGEFs. Since several RalGEFs are downstream effectors of Ras, Ral is activated by the oncogenic mutant Ras. Ral is negatively regulated by RalGAP complexes that consist of a catalytic α1 or α2 subunit and its common partner β subunit and similarly regulate the activity of RalA as well as RalB in vitro. Ral plays an important role in the formation and progression of pancreatic and lung cancers. However, the involvement of Ral in oral squamous cell carcinoma (OSCC) is unclear. In this study, we investigated OSCC by focusing on Ral. OSCC cell lines with high Ral activation exhibited higher motility. We showed that knockdown of RalGAPβ increased the activation level of RalA and promoted the migration and invasion of HSC-2 OSCC cells in vitro. In contrast, overexpression of wild-type RalGAPα2 in TSU OSCC cells attenuated the activation level of RalA and inhibited cell migration and invasion. Real-time quantitative polymerase chain reaction analysis of samples from patients with OSCC showed that RalGAPα2 was downregulated in oral cancer tissues as compared with normal epithelia. Among patients with OSCC, those with a lower expression of RalGAPα2 showed a worse overall survival rate. A comparison of DNA methylation and histone modifications of the RalGAPα2 gene in OSCC cell lines suggested that crosstalk among DNA methylation, histone H4Ac, and H3K27me2 was involved in the downregulation of RalGAPα2. Thus, activation of Ral GTPase by downregulation of RalGAP expression via a potential epigenetic mechanism may enhance OSCC progression.

Claudin-7 (CLDN7) is overexpressed in gastric cancer and promotes gastric cancer cell proliferation, invasion and maintains mesenchymal state

Gastric cancer (GC) ranks as the fourth most common cancer worldwide and is among the most aggressive types of cancer. Claudin-7 (CLDN7) has been found to be aberrantly expressed in some types of cancers. However, the expression and role of CLDN7 on gastric cancer (GC) remain largely unknown. In this study, we have performed the largest expression analysis study to date of CLDN7 in 113 pairs of human GC tissues and non-tumorous adjacent tissues. We found CLDN7 expression is significantly elevated in GC tissues, and the overexpression of CLDN7 is closely related to lymph node metastasis. Furthermore, we observed that CLDN7 executes an oncogenic function, promoting cancer cell proliferation, invasion, and epithelial-mesenchymal transition in GC. Given this oncogenic role of CLDN7 in GC formation and progression, CLDN7 may have an indispensable potential for future anti-metastatic and therapeutic applications.

[Analysis of aluminum content in unprocessed grains from different areas of China]

Objective: To investigate the aluminium content in unprocessed grains from different areas of China. Methods: From June 2013 to December 2014, nine provinces (Jilin, Shandong, Hubei, Hunan, Guangdong, Guangxi, Henan, Anhui and Jiangsu) were selected as sampling areas using stratified random sampling method. Three cities, counties or townships were randomly selected from each sampling area. Grain stations, grain depots, planting areas or farmers' markets located in non-aluminium mining areas or non-aluminium-involved industrial pollution areas were selected from each sampling area using a purposive sampling method. A total of 470 unprocessed grain samples (500 g per sample) including wheat, rice, corn, millet and soybean were collected from local grain stations, grain depots, planting areas and farmers' markets. The dried grains samples were analysed for aluminium content by inductively coupled plasma mass spectrometry. Bootstrap resampling method was applied to calculate the upper bound values of 95%CI of P(99) of aluminium contents for each kind of grain, which could be regarded as levels of concern for corresponding categories. Results: A total of 454 grain samples, including 109 wheat samples, 111 rice samples, 78 corn samples, 69 millet samples and 87 soybean samples, were used for analysis after excluding outlier values. There were 420 positive samples with detected aluminium and the overall detection rate was 92.5%. Among them, the aluminium contents were high in wheat and soybean with median values about 9.59 and 7.12 mg/kg, and maximum values about 31.55 and 28.80 mg/kg, respectively. The median and maximum values of aluminium contents in corn were about 4.65 and 26.79 mg/kg. Aluminium contents were low in rice and millet, with median values about 1.49 and 2.21 mg/kg, and maximum values about 7.56 and 8.07 mg/kg, respectively. Based on Bootstrap resampling method, the upper bound values of 95%CI of P(99) of aluminium contents in wheat, soybean, corn, rice and millet were 29.86, 28.80, 26.79, 7.56 and 8.07 mg/kg, respectively, which could be regarded as levels of concern for corresponding grains. Conclusion: Aluminium has been detected in most unprocessed grains. The accumulation of aluminium varies in different grains species.

[A petition to American philanthropist for the donation of an American hospital in Tianjin]

At the dawn of the Republic of China, a group of doctors, educators, businessmen, officials, and the America returned Students in Tianjin jointly submitted a petition to American philanthropist for donation of a large-scale modern hospital. This petition, appended to a report to Carnegie Endowment for International Peace, has long been neglected by researchers. The memorandum may be informative to study local medical service at a transition period, and also helps understand the establishment and subsequent contribution of China Medical Board.

Microarray analysis of long non-coding RNAs related to microRNA-148b in gastric cancer

The miR-148/152 family (miR-148a, miR-148b, miR-152) is differentially expressed in gastric cancer tissues and non-tumor tissues. Our previous studies indicated that miR-148/152 family is important in the tumorigenesis and development of gastric cancer. We also found several target genes that were regulated by the miR-148/152 family and several factors that could influence members of this family. However, the molecular mechanisms and function of this family in gastric cancer remain unclear. Recently, long non-coding RNAs (lncRNAs) have been found to play an important role in the pathogenesis of many diseases. The aim of the present study was to perform expression profiling to identify lncRNAs that might be associated with miR-148b in gastric cancer and predict their potential functions. Total RNA was extracted from gastric cancer cell line SGC-7901 treated with miR-148b mimics and from untreated gastric cancer cells. Microarray analysis was performed using the Agilent LncRNA + mRNA Human Gene Expression Microarray V3.0 platform, which was designed for the profiling of human lncRNAs and protein-coding transcripts. A total of 37581 lncRNA and 34303 mRNA transcripts were detected in gastric cancer cell line SGC-7901 and cell line SGC-7901 treated with miR-148b mimics. Among the differentially expressed lncRNAs, 240 up-regulated and 64 down-regulated lncRNAs were identified. XLOC_000983 was the most up-regulated lncRNA, and M18204.1 was the most down-regulated lncRNA. Among the differentially expressed mRNAs in different cell lines, 196 were consistently up-regulated and 320 were consistently down-regulated. POSTN was the most up-regulated mRNA, and HBB was the most down-regulated mRNA. Gene Ontology (GO) and pathway analyses indicated that the lncRNAs influenced by miR-148b might play an important role in the immune system and were associated with the development of gastric cancer. The altered expression of lncRNAs influenced by miR-148b may play a partial role in pathways implicated in gastric cancer development and progression, such as the immune response pathway.

[Exposure status and health risk assessment of deoxynivalenol from cereals in Chinese population in different regions]

Objective: To evaluate the dietary exposure to deoxynivalenol (DON) from cereals and health risk in Chinese residents in different regions. Methods: The data of DON concentration in cereals was derived from the national food safety risk surveillance from 2010 to 2017, with 15 422 samples of cereals included. China was roughly divided into north part and south part, along with the Qinling Mountains-Huaihe River line. Sample size of each type of cereals, i.e. wheat flour, maize meal, oats and rice was 4 948, 696, 626, 1 006 in the north, while 5 648, 1 068, 266, 1 164 in the south. The data of cereals consumption was derived from China National Nutrition and Health Survey in 2002 and 68 335 respondents aged 3 and above, with 34 234 from the north and 34 101 from the south, were included. Simple distribution model was applied for calculation and comparison of the dietary exposure to DON from cereals in northern and southern residents based on individual consumption of cereals, body weight and average DON concentration in each type of cereals. Results: Average DON concentration in wheat flour, maize meal, oats, and rice sampled in northern China were 235.4, 121.6, 7.0 and 4.6 μg/kg, respectively, while 239.1, 124.3, 29.0 and 15.5 μg/kg in cereals sampled in southern China. The average DON exposure from cereals in surveyed Chinese inhabitants was 0.78 μg/(kg·d). Among them, the DON exposure of northern residents was higher than that of southern residents (P<0.001), and the average exposures were 1.15 and 0.41 μg/(kg·d), respectively. A total of 49.2% of northern residents exceeded provisional maximum tolerable daily intake for DON exposure from cereals, which was much higher than that of southern residents (8.6%) (P<0.001). Wheat-based food products were the main source of DON exposure, with a contribution rate of 96.5% in the north and 68.3% in the south. Average DON exposure was the highest in the 3-6 years [2.12 μg/(kg·d) for children in north and 0.73 μg/(kg·d) in south]. Conclusion: Exposure to DON from cereals in northern residents of China was considerably high, with a certain health risk. Northern children aged 3 to 6 exposed even more DON and needed significant attention.

Factors Influencing Rust (Melampsora apocyni) Intensity on Cultivated and Wild Apocynum venetum in Altay Prefecture, China

Rust (Melampsora apocyni) on Apocynum venetum is the major constraint to the commercial development of this medicinal herb. To determine the factors influencing rust intensity (maximum disease index [DI_max]), rust was investigated from 2011 to 2015 in both cultivated and wild A. venetum plants. Partial least squares path modeling (PLS-PM) was used to analyze the paths and extent of the factors related to pathogen, environment, and host that affect rust intensity. DI_max exhibited considerable variations across years and study sites, with variations linked to various factors fostering disease development. PLS-PM explained 80.0 and 70.1% of variations in DI_max in cultivated and wild plants, respectively. Precipitation was the key factor determining DI_max in both cultivated and wild plants (path coefficient [PC] = 0.313 and 0.544, respectively). In addition, the topsoil water content in cultivated plants and the total vegetation coverage in wild plants were also critical determinants of DI_max via their effects on the microclimatic factor (contribution coefficients [CC] = 0.681 and 0.989, respectively; PC = 0.831 and 0.231, respectively). In both cultivated and wild plants, host factors were mainly dominated by A. venetum density (CC = 0.989 and 0.894, respectively), and their effect on DI_max via the microclimatic factor (PC = 0.841 and 0.862, respectively) exceeded that via the inoculum factor (PC = 0.705 and 0.130, respectively). However, the indirect effects led to DI_max variation, while the dilution effect on host (CC = 0.154) from weed in wild plants led to the indirect effect size in wild plants of 0.200, which was lower than -0.699 in cultivated plants.